Healthcare Provider Details

I. General information

NPI: 1306867510
Provider Name (Legal Business Name): SAMUEL ALAISH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 05/06/2022
Certification Date: 05/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ORLEANS ST RM 7337
BALTIMORE MD
21287-0010
US

IV. Provider business mailing address

PO BOX 64226
BALTIMORE MD
21264-4742
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-2960
  • Fax: 410-502-5314
Mailing address:
  • Phone: 410-328-6897
  • Fax: 410-328-2109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD0059192
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: