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NPI Code Detail

MEDICARE: MARIAM KHAN

MEDICARE: MARIAM KHAN
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
1208000000XPediatrics Physician25MA07432300NJ
2208000000XPediatrics PhysicianME154297FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1528677085
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIAM KHAN
Provider Business Mailing Address
First Line : 110 S WOODLAND ST
Second Line :
City : WINTER GARDEN
State : FL
Zip : 34787-3546
Country : US
Telephone Number : 407-409-2222
Fax Number : 407-905-8998
Provider Business Practice Location Address
First Line : 19108 E COLONIAL DR
Second Line :
City : ORLANDO
State : FL
Zip : 32820-3701
Country : US
Telephone Number : 407-905-8827
Fax Number : 407-660-1667
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2020
Last Update Date : 08/16/2022

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Directions to “ MARIAM KHAN ” Practice Location

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