Healthcare Provider Details

I. General information

NPI: 1467452490
Provider Name (Legal Business Name): TODD LOUIS SAMUELS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 WEST RD STE 101
TOWSON MD
21204-2326
US

IV. Provider business mailing address

22 WEST RD STE 101
TOWSON MD
21204-2326
US

V. Phone/Fax

Practice location:
  • Phone: 410-823-3600
  • Fax: 410-823-3605
Mailing address:
  • Phone: 410-823-3600
  • Fax: 410-823-3605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberD0035847
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: