Provider Demographics
NPI:1811350408
Name:FARIS, MARIAM ELIZABETH (DO)
Entity type:Individual
Prefix:DR
First Name:MARIAM
Middle Name:ELIZABETH
Last Name:FARIS
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:410-933-6423
Mailing Address - Fax:410-500-4266
Practice Address - Street 1:8600 OLD GEORGETOWN RD FL 4
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1422
Practice Address - Country:US
Practice Address - Phone:301-896-3468
Practice Address - Fax:301-896-8113
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01022067392084P0800X
390200000X
MDH864152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program