Healthcare Provider Details

I. General information

NPI: 1578636718
Provider Name (Legal Business Name): SAMEER P SARKAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RAF LAKENHEATH 48 MDG/SGHC UNIT 5115
APO AE
09461-5115
US

IV. Provider business mailing address

RAF LAKENHEATH 48 MDG/SGHC UNIT 5115
APO AE
09461-5115
US

V. Phone/Fax

Practice location:
  • Phone: 314-226-8603
  • Fax:
Mailing address:
  • Phone: 314-226-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number209982
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number209982
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: