MEDICARE: DR. RAJ SAMTANI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	D0027744	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	47270	OTHER	MD	MAMSI
2	47270	OTHER	DC	OPTIMUM CHOICE
3	5352-0001	OTHER	DC	BC BS NCA

General Provider Information

NPI Number	:	1417938390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAJ SAMTANI M.D.

Provider Business Mailing Address
First Line	:	9131 PISCATAWAY RD
Second Line	:	SUITE 280
City	:	CLINTON
State	:	MD
Zip	:	20735-2508
Country	:	US
Telephone Number	:	301-868-3003
Fax Number	:	301-932-8544

Provider Business Practice Location Address
First Line	:	9131 PISCATAWAY RD
Second Line	:	SUITE 280
City	:	CLINTON
State	:	MD
Zip	:	20735-2508
Country	:	US
Telephone Number	:	301-868-3003
Fax Number	:	301-932-8544

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	07/08/2007

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