Provider Demographics
NPI:1740320134
Name:PARVEEN, MARIUM (MD)
Entity type:Individual
Prefix:
First Name:MARIUM
Middle Name:
Last Name:PARVEEN
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 1:15886 GAITHER DR STE B
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-1404
Mailing Address - Country:US
Mailing Address - Phone:822-814-6862
Mailing Address - Fax:240-241-6445
Practice Address - Street 1:15886 GAITHER DR STE B
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1404
Practice Address - Country:US
Practice Address - Phone:822-814-6862
Practice Address - Fax:240-241-6445
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD306862084P0800X
MDD00464572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0046457OtherSTATE LICENSE
MDD0046457OtherSTATE LICENSE
MDG07892Medicare UPIN