Provider Demographics
NPI:1497814966
Name:QAYUM, MARYAM (MD)
Entity Type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:QAYUM
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 1:22704 LOOP 494 STE E
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2858
Mailing Address - Country:US
Mailing Address - Phone:832-583-7264
Mailing Address - Fax:832-583-7244
Practice Address - Street 1:22704 LOOP 494 STE E
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2858
Practice Address - Country:US
Practice Address - Phone:832-583-7264
Practice Address - Fax:832-583-7244
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6250208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1492701Medicaid
TX8F5692Medicare PIN
TX00393FMedicare ID - Type UnspecifiedMEDICARE #