Provider Demographics
NPI:1093795759
Name:MAMMEN, MARIAM C (MD)
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:C
Last Name:MAMMEN
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:501 W 14TH ST
Mailing Address - Street 2:WILMINGTON HOSPITAL, DEPARTMENT OF PSYCHIATRY
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-1013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 W 14TH ST
Practice Address - Street 2:WILMINGTON HOSPITAL, DEPARTMENT OF PSYCHIATRY
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-1013
Practice Address - Country:US
Practice Address - Phone:302-428-2100
Practice Address - Fax:302-428-2121
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC100020412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE003385C60Medicare PIN
DEB66582Medicare UPIN