Healthcare Provider Details

I. General information

NPI: 1689779399
Provider Name (Legal Business Name): SAMUEL O PAIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N GREENE ST DEPARTMENT OF RADIOLOGY
BALTIMORE MD
21201-1524
US

IV. Provider business mailing address

12111 HENESON GARTH
OWINGS MILLS MD
21117-1631
US

V. Phone/Fax

Practice location:
  • Phone: 410-605-7175
  • Fax: 410-605-7925
Mailing address:
  • Phone: 443-394-8632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberD0028150
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: