Healthcare Provider Details

I. General information

NPI: 1265753883
Provider Name (Legal Business Name): SAMI MOURAD M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 FOREST GLEN RD
SILVER SPRING MD
20910-1483
US

IV. Provider business mailing address

1500 FOREST GLEN RD PO BOX 83819
SILVER SPRING MD
20910-1483
US

V. Phone/Fax

Practice location:
  • Phone: 301-754-7991
  • Fax:
Mailing address:
  • Phone: 301-754-7991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberD0070793
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: