Provider Demographics
NPI:1578983029
Name:AHMED, MARIAM J (MD)
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:J
Last Name:AHMED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 W ESPLANADE AVE
Mailing Address - Street 2:SUITE # 412
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2489
Mailing Address - Country:US
Mailing Address - Phone:504-464-2940
Mailing Address - Fax:504-464-2941
Practice Address - Street 1:200 W ESPLANADE AVE
Practice Address - Street 2:SUITE # 412
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2489
Practice Address - Country:US
Practice Address - Phone:504-464-2940
Practice Address - Fax:504-464-2941
Is Sole Proprietor?:No
Enumeration Date:2014-04-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXS2208207QG0300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program