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General NPI Number Information
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NPI Number | 1689695611
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Entity Type | Individual
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Provider Name | MARYAM M PASHA MD
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Gender | Female
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 02/29/2024
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Provider Practice Location Address
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Address Line | 1023 N LIBERTY ST
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City | JACKSONVILLE
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State | FL
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Zip | 32206-5767
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Country | US
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Telephone | 305-988-5262
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Fax |
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Provider Business Mailing Address
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Address Line | 221 N HOGAN ST
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City | JACKSONVILLE
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State | FL
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Zip | 32202-4201
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Country | US
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Telephone | 305-988-5262
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME78800
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036.155534
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License Number State | IL
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