Healthcare Provider Details

I. General information

NPI: 1114455987
Provider Name (Legal Business Name): MOHAMMAD SAMER YOUNES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2017
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 WOODLAND STREET
HARTFORD CT
06105
US

IV. Provider business mailing address

41 SANDERSON RD
SMITHFIELD RI
02917-2602
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-7527
  • Fax:
Mailing address:
  • Phone: 401-456-2525
  • Fax: 401-456-2684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD17061
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: