Healthcare Provider Details

I. General information

NPI: 1861012593
Provider Name (Legal Business Name): MARYAM SADIQ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 PARK AVE
IRONTON OH
45638-1596
US

IV. Provider business mailing address

PO BOX 1595
ASHLAND KY
41105-1595
US

V. Phone/Fax

Practice location:
  • Phone: 740-532-9403
  • Fax: 740-532-9425
Mailing address:
  • Phone: 606-408-9571
  • Fax: 606-408-6061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.148108
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: