Healthcare Provider Details

I. General information

NPI: 1881377612
Provider Name (Legal Business Name): MARIAM MOHAMMAD YASIN IQNEIBI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5280 BEECHMONT AVE FL OH452302
CINCINNATI OH
45230-2502
US

IV. Provider business mailing address

5280 BEECHMONT AVE FL OH452302
CINCINNATI OH
45230-2502
US

V. Phone/Fax

Practice location:
  • Phone: 513-492-1605
  • Fax:
Mailing address:
  • Phone: 513-492-1605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.151701
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number57.253116
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: