Healthcare Provider Details

I. General information

NPI: 1881836476
Provider Name (Legal Business Name): SAMIR F JAIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2009
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 PAWNEE CT
NEWARK DE
19702
US

IV. Provider business mailing address

127 PAWNEE CT
NEWARK DE
19702-1911
US

V. Phone/Fax

Practice location:
  • Phone: 302-379-9718
  • Fax:
Mailing address:
  • Phone: 484-565-1510
  • Fax: 484-565-1513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLP01023
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD439895
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD439895
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: