Provider Demographics
NPI:1962799775
Name:IMAM, SARDAR ZAKARIYA (MD)
Entity type:Individual
Prefix:DR
First Name:SARDAR
Middle Name:ZAKARIYA
Last Name:IMAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 E 30TH ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-8900
Mailing Address - Country:US
Mailing Address - Phone:505-564-6850
Mailing Address - Fax:505-564-6890
Practice Address - Street 1:2325 E 30TH ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-8900
Practice Address - Country:US
Practice Address - Phone:505-564-6850
Practice Address - Fax:505-564-6890
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2014-0182207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology