Provider Demographics
NPI:1154142719
Name:MARIAM PA-C LLC
Entity type:Organization
Organization Name:MARIAM PA-C LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAEED
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIRI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:302-359-3021
Mailing Address - Street 1:8420 DORSEY CIR STE 201
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-8300
Mailing Address - Country:US
Mailing Address - Phone:302-359-3021
Mailing Address - Fax:
Practice Address - Street 1:8420 DORSEY CIR STE 201
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-8300
Practice Address - Country:US
Practice Address - Phone:302-359-3021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty