Provider Demographics
NPI:1346381365
Name:KHAWARI, MARYAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MARYAM
Middle Name:
Last Name:KHAWARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11569 S HIGHWAY 6
Mailing Address - Street 2:PMB 197
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-4932
Mailing Address - Country:US
Mailing Address - Phone:281-652-5943
Mailing Address - Fax:281-652-5944
Practice Address - Street 1:777 S FRY RD STE 102
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-2297
Practice Address - Country:US
Practice Address - Phone:281-652-5943
Practice Address - Fax:281-652-5944
Is Sole Proprietor?:No
Enumeration Date:2007-02-11
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY47166207RR0500X
TXS9724207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1346381365OtherALL COMERICIAL
TX1W7221OtherMEDICARE
KY47166OtherKY STATE LICENSE
TX431614301Medicaid