Provider Demographics
NPI:1164907507
Name:OWEIS, MARIAM D (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:D
Last Name:OWEIS
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:4 EVES DR STE A100
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3126
Mailing Address - Country:US
Mailing Address - Phone:609-267-9400
Mailing Address - Fax:609-267-9457
Practice Address - Street 1:401 YOUNG AVE STE 245
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3132
Practice Address - Country:US
Practice Address - Phone:609-267-9400
Practice Address - Fax:609-267-9457
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00496400363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical