Provider Demographics
NPI:1689864936
Name:BAKHTAR, MARYAM (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARYAM
Middle Name:
Last Name:BAKHTAR
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 1:900 BUSINESS CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044
Mailing Address - Country:US
Mailing Address - Phone:215-442-7722
Mailing Address - Fax:215-957-0563
Practice Address - Street 1:900 BUSINESS CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044
Practice Address - Country:US
Practice Address - Phone:215-442-7722
Practice Address - Fax:215-957-0563
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027426E207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E60391Medicare UPIN