MEDICARE: DR. MARYAM ZAMANIAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	M0612	TX
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	M0612	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8S0451	OTHER	TX	BCBS
3	8W2882	OTHER	TX	BCBSTX
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174508311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARYAM ZAMANIAN MD

Provider Business Mailing Address
First Line	:	3600 GASTON AVE
Second Line	:	SUITE 454
City	:	DALLAS
State	:	TX
Zip	:	75246-1800
Country	:	US
Telephone Number	:	214-820-8940
Fax Number	:	214-820-8944

Provider Business Practice Location Address
First Line	:	3600 GASTON AVE
Second Line	:	SUITE 454
City	:	DALLAS
State	:	TX
Zip	:	75246-1800
Country	:	US
Telephone Number	:	214-820-8940
Fax Number	:	214-820-8944

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	10/28/2011

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Directions to “ DR. MARYAM ZAMANIAN MD” Practice Location

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