Provider Demographics
NPI:1679825384
Name:BEKLIK, MARYAM (CRNA)
Entity Type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:BEKLIK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 SUGAR TREE PL
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-3140
Mailing Address - Country:US
Mailing Address - Phone:405-593-1092
Mailing Address - Fax:
Practice Address - Street 1:30 SUGAR TREE PL
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-3140
Practice Address - Country:US
Practice Address - Phone:405-593-1092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR124129367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered