Provider Demographics
NPI:1902398662
Name:ZAGHAB-MATHEWS, SORIAYAH MARIE (MD)
Entity Type:Individual
Prefix:
First Name:SORIAYAH
Middle Name:MARIE
Last Name:ZAGHAB-MATHEWS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SORAIYAH
Other - Middle Name:MARIE
Other - Last Name:ZAGHAB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 GREENE ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2799
Mailing Address - Country:US
Mailing Address - Phone:301-724-7616
Mailing Address - Fax:
Practice Address - Street 1:500 GREENE ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2799
Practice Address - Country:US
Practice Address - Phone:301-724-7616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDD0091344208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program