Provider Demographics
NPI:1689695611
Name:PASHA, MARYAM M (MD)
Entity Type:Individual
Prefix:DR
First Name:MARYAM
Middle Name:M
Last Name:PASHA
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 1:221 N HOGAN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-4201
Mailing Address - Country:US
Mailing Address - Phone:305-988-5262
Mailing Address - Fax:
Practice Address - Street 1:1023 N LIBERTY ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-5767
Practice Address - Country:US
Practice Address - Phone:305-988-5262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78800207P00000X
IL036.155534207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3004678-00Medicaid
CAAV831ZMedicare PIN
FL49122AMedicare ID - Type Unspecified
CAAV831XMedicare PIN
FL3004678-00Medicaid