Provider Demographics
NPI:1639574403
Name:ENDOCRINOLOGY AND DIABETES SPECIALIST PA
Entity Type:Organization
Organization Name:ENDOCRINOLOGY AND DIABETES SPECIALIST PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-998-6711
Mailing Address - Street 1:11970 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 630
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3768
Mailing Address - Country:US
Mailing Address - Phone:972-998-6711
Mailing Address - Fax:972-421-1677
Practice Address - Street 1:11970 N CENTRAL EXPY
Practice Address - Street 2:SUITE 630
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3768
Practice Address - Country:US
Practice Address - Phone:972-998-6711
Practice Address - Fax:972-421-1677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0612261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty