Healthcare Provider Details

I. General information

NPI: 1932387578
Provider Name (Legal Business Name): MARYAM AWAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 E PULASKI HWY STE C
ELKTON MD
21921-6037
US

IV. Provider business mailing address

677 E PULASKI HWY STE C
ELKTON MD
21921-6037
US

V. Phone/Fax

Practice location:
  • Phone: 410-398-0590
  • Fax: 410-392-9408
Mailing address:
  • Phone: 410-620-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMT182825
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC1-0008901
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: