Healthcare Provider Details

I. General information

NPI: 1740742584
Provider Name (Legal Business Name): AMARE SAMUEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: AMARE SAMUEL TESFASELASSIE

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL RD
PRINCE FREDERICK MD
20678-4017
US

IV. Provider business mailing address

3900 HAMILTON ST APT B203
HYATTSVILLE MD
20781-1865
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-4000
  • Fax:
Mailing address:
  • Phone: 702-439-1673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0094878
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberD94878
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: