Healthcare Provider Details

I. General information

NPI: 1982839635
Provider Name (Legal Business Name): SAMUEL HAHN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 N CHARLES ST SUITE 601
BALTIMORE MD
21204-6800
US

IV. Provider business mailing address

6565 N CHARLES ST SUITE 601
BALTIMORE MD
21204-6800
US

V. Phone/Fax

Practice location:
  • Phone: 410-821-5151
  • Fax: 443-823-8309
Mailing address:
  • Phone: 410-821-5151
  • Fax: 443-823-8309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberD0081400
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: