Healthcare Provider Details

I. General information

NPI: 1275532129
Provider Name (Legal Business Name): SAMER AZOUZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12311 PERRY HWY
WEXFORD PA
15090-8344
US

IV. Provider business mailing address

12311 PERRY HWY
WEXFORD PA
15090-8344
US

V. Phone/Fax

Practice location:
  • Phone: 878-332-4214
  • Fax: 878-332-4468
Mailing address:
  • Phone: 878-332-4214
  • Fax: 878-332-4468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD070611L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberMD070611L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD070611L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: