Provider Demographics
NPI:1083355283
Name:RAHMAN, MARIAM KHALIL (MA)
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:KHALIL
Last Name:RAHMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:778 NOSTRAND AVE # 2F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-4224
Mailing Address - Country:US
Mailing Address - Phone:718-427-0703
Mailing Address - Fax:
Practice Address - Street 1:1493 CAMBRIDGE ST RM 239
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1099
Practice Address - Country:US
Practice Address - Phone:617-575-5399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program