Healthcare Provider Details

I. General information

NPI: 1851435127
Provider Name (Legal Business Name): NADIA ADJOA SAM-AGUDU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NADIA ADJOA SAM MD

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 01/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

PO BOX 62063
BALTIMORE MD
21264-2063
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-6749
  • Fax: 410-328-7305
Mailing address:
  • Phone: 410-706-5181
  • Fax: 410-706-5103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number47366
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number11026
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberD72274
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: