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General NPI Number Information
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NPI Number | 1205077633
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Entity Type | Individual
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Provider Name | MARYAM INANLOO M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/15/2009
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Last Update Date | 03/15/2009
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Provider Practice Location Address
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Address Line | 877 CHALKSTONE AVE
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City | PROVIDENCE
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State | RI
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Zip | 02908-4728
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Country | US
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Telephone | 401-456-2179
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Fax |
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Provider Business Mailing Address
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Address Line | 903 PROVIDENCE PL APT #204
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City | PROVIDENCE
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State | RI
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Zip | 02903-7000
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Country | US
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Telephone | 571-220-0854
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | LP01420
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License Number State | RI
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