Provider Demographics
NPI:1023490448
Name:FAROOQ, MARYAM
Entity type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:FAROOQ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 MARYLAND RD STE 400
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1225
Mailing Address - Country:US
Mailing Address - Phone:215-481-4143
Mailing Address - Fax:215-481-6790
Practice Address - Street 1:605 N BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:LOWER GWYNEDD
Practice Address - State:PA
Practice Address - Zip Code:19002-2501
Practice Address - Country:US
Practice Address - Phone:215-643-2119
Practice Address - Fax:215-643-3568
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-22
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS019656207R00000X, 207RG0300X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine