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NPI Code Detail

MEDICARE: DR. MARYAM POURSARTIP M.D.

MEDICARE: DR. MARYAM POURSARTIP M.D.
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
1207R00000XInternal Medicine Physician003535NY

General Provider Information

NPI Number : 1225298110
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARYAM POURSARTIP M.D.
Provider Business Mailing Address
First Line : 111 SHORELINE DR
Second Line :
City : RANCHO MIRAGE
State : CA
Zip : 92270-5813
Country : US
Telephone Number : 917-575-6669
Fax Number :
Provider Business Practice Location Address
First Line : 66675 PIERSON BLVD
Second Line :
City : DESERT HOT SPRINGS
State : CA
Zip : 92240-3737
Country : US
Telephone Number : 760-676-5240
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2008
Last Update Date : 05/22/2015

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