Provider Demographics
NPI:1427742931
Name:ASHOOR, MARYAM FAREED (MD)
Entity type:Individual
Prefix:
First Name:MARYAM
Middle Name:FAREED
Last Name:ASHOOR
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 1:300 LONGWOOD AVE BOSTON CHILDREN'S HOSPITAL
Mailing Address - Street 2:FEGAN 6
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:857-381-2802
Mailing Address - Fax:
Practice Address - Street 1:300 LONGWOOD AVE BOSTON CHILDREN'S HOSPITAL
Practice Address - Street 2:FEGAN 6
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:857-381-2802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3013631390200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program