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General NPI Number Information
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NPI Number | 1508228834
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Entity Type | Individual
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Provider Name | MARIAM KEITA DO
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Gender | Female
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Dates
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Enumeration Date | 03/25/2016
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Last Update Date | 08/08/2024
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Provider Practice Location Address
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Address Line | 8 MOUNTAIN BLVD STE J
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City | WARREN
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State | NJ
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Zip | 07059-2638
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Country | US
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Telephone | 732-893-0200
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Fax | 908-754-0141
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Provider Business Mailing Address
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Address Line | 379 CAMPUS DR FL 4
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City | SOMERSET
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State | NJ
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Zip | 08873-1161
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Country | US
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Telephone | 732-937-8939
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Fax | 732-418-8372
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 25MB10712900
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License Number State | NJ
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