Provider Demographics
NPI:1447613690
Name:ABID, MARYAM
Entity Type:Individual
Prefix:DR
First Name:MARYAM
Middle Name:
Last Name:ABID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 W TIMBERLANE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33566-0957
Mailing Address - Country:US
Mailing Address - Phone:813-754-4611
Mailing Address - Fax:813-443-8169
Practice Address - Street 1:1601 W TIMBERLANE DR STE 300
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33566-0957
Practice Address - Country:US
Practice Address - Phone:813-754-4611
Practice Address - Fax:813-443-8169
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS15858207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104014500Medicaid