Provider Demographics
NPI:1992782577
Name:MARJIEH, ZIAD M (MD)
Entity type:Individual
Prefix:
First Name:ZIAD
Middle Name:M
Last Name:MARJIEH
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 1:2100 NEBRASKA AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4704
Mailing Address - Country:US
Mailing Address - Phone:772-461-0915
Mailing Address - Fax:772-461-3825
Practice Address - Street 1:2100 NEBRASKA AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4704
Practice Address - Country:US
Practice Address - Phone:772-461-0915
Practice Address - Fax:772-461-3825
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47006207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME47006OtherMEDICAL LICENSE
FL041814500Medicaid
FLME47006OtherMEDICAL LICENSE
FLD56781Medicare UPIN