Provider Demographics
NPI:1538504204
Name:MAHARAM, EDWARD R (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:R
Last Name:MAHARAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 N ORANGE AVE STE 235
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4659
Mailing Address - Country:US
Mailing Address - Phone:407-303-7270
Mailing Address - Fax:407-303-2553
Practice Address - Street 1:2501 N ORANGE AVE STE 235
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4659
Practice Address - Country:US
Practice Address - Phone:407-303-7270
Practice Address - Fax:407-303-2553
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD56086207R00000X
AZR73810207R00000X
TN56086208M00000X
FLME140421207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist