Healthcare Provider Details

I. General information

NPI: 1164096798
Provider Name (Legal Business Name): MARYAM MAROOF KHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 CHESTNUT ST
PHILADELPHIA PA
19107-4414
US

IV. Provider business mailing address

2305 BAY LAKES CT
ARLINGTON TX
76016-1176
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-1085
  • Fax: 215-955-5041
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number338324-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: