Healthcare Provider Details

I. General information

NPI: 1891781118
Provider Name (Legal Business Name): DRS MUNIR & SAMAD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 BALDWIN BLVD
SHAMOKIN DAM PA
17876
US

IV. Provider business mailing address

PO BOX 427 99 BALDWIN BLVD
SHAMOKIN DAM PA
17876
US

V. Phone/Fax

Practice location:
  • Phone: 570-743-7657
  • Fax: 570-743-0047
Mailing address:
  • Phone: 570-743-7657
  • Fax: 570-743-0047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD034193L
License Number StatePA

VIII. Authorized Official

Name: DR. MOHAMMAD M MUNIR
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 570-743-7657