Provider Demographics
NPI:1407618796
Name:JAMAL, MARIAM KHALED (OD)
Entity Type:Individual
Prefix:DR
First Name:MARIAM
Middle Name:KHALED
Last Name:JAMAL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:3214 CHARLES B ROOT WYND STE 120
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-5440
Practice Address - Country:US
Practice Address - Phone:919-881-0900
Practice Address - Fax:919-881-0911
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2786152W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program