Healthcare Provider Details

I. General information

NPI: 1073639118
Provider Name (Legal Business Name): SAMUEL G. MALLER M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 N LEISURE WORLD BLVD
SILVER SPRING MD
20906-1367
US

IV. Provider business mailing address

PO BOX 709
OLNEY MD
20830-0709
US

V. Phone/Fax

Practice location:
  • Phone: 301-598-1590
  • Fax: 301-598-1569
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0050612
License Number StateMD

VIII. Authorized Official

Name: DR. SAMUEL MALLER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 301-675-6589