Provider Demographics
NPI:1053726349
Name:DR MARIAM ORJI, MD
Entity type:Organization
Organization Name:DR MARIAM ORJI, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MARIAM
Authorized Official - Middle Name:UJU
Authorized Official - Last Name:ORJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-321-3536
Mailing Address - Street 1:2850 SHORELINE TRL
Mailing Address - Street 2:PMB 250
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-5508
Mailing Address - Country:US
Mailing Address - Phone:214-321-3536
Mailing Address - Fax:214-321-3520
Practice Address - Street 1:1151 N BUCKNER BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-3426
Practice Address - Country:US
Practice Address - Phone:214-321-3536
Practice Address - Fax:214-321-3520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-25
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9105208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty