Provider Demographics
NPI:1528142387
Name:KARAM, MAROUN
Entity type:Individual
Prefix:
First Name:MAROUN
Middle Name:
Last Name:KARAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 S PERRY ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095-2316
Mailing Address - Country:US
Mailing Address - Phone:518-736-1500
Mailing Address - Fax:518-762-8194
Practice Address - Street 1:23 S PERRY ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-2316
Practice Address - Country:US
Practice Address - Phone:518-736-1500
Practice Address - Fax:518-762-8194
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY157850207R00000X, 207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00997764Medicaid
NYDD1280Medicare PIN
NYA61484Medicare UPIN