Healthcare Provider Details

I. General information

NPI: 1518595222
Provider Name (Legal Business Name): MARJAN HAIDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2020
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 WOLF RIVER BLVD STE 200
GERMANTOWN TN
38138-1755
US

IV. Provider business mailing address

PO BOX 381468
GERMANTOWN TN
38183-1468
US

V. Phone/Fax

Practice location:
  • Phone: 901-747-3630
  • Fax: 901-747-4149
Mailing address:
  • Phone:
  • Fax: 901-328-1355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number36894
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number76421
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: