Provider Demographics
NPI:1316526759
Name:ALSHAGRA, MARIAM (DO)
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:
Last Name:ALSHAGRA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E UNIVERSITY PKWY DEPT OF
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2829
Mailing Address - Country:US
Mailing Address - Phone:410-554-2284
Mailing Address - Fax:410-554-2184
Practice Address - Street 1:6821 REISTERSTOWN RD STE 106
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-1434
Practice Address - Country:US
Practice Address - Phone:410-358-6450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102208778207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine