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General NPI Number Information
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NPI Number | 1205127404
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Entity Type | Individual
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Provider Name | MARYAM TABRIZI M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/22/2011
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Last Update Date | 12/26/2017
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Provider Practice Location Address
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Address Line | 501 W 14TH STREET
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City | WILMINGTON
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State | DE
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Zip | 19801-1013
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Country | US
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Telephone | 302-320-4410
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Fax | 785-273-0524
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Provider Business Mailing Address
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Address Line | 200 HYGEIA DRIVE SUITE 2300
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City | NEWARK
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State | DE
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Zip | 19713-2049
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Country | US
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Telephone | 785-273-7571
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Fax | 785-273-0524
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 04-37330
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | C1-0012410
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License Number State | DE
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