Healthcare Provider Details

I. General information

NPI: 1750273108
Provider Name (Legal Business Name): SAMIRA H LILAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12837 GRAND ELM ST
CLARKSBURG MD
20871-4393
US

IV. Provider business mailing address

12837 GRAND ELM ST
CLARKSBURG MD
20871-4393
US

V. Phone/Fax

Practice location:
  • Phone: 240-821-3931
  • Fax:
Mailing address:
  • Phone: 240-821-3931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberRSA-02616
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberRSA-20616
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRSA-02616
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: