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General NPI Number Information
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NPI Number | 1104963990
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Entity Type | Organization
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Legal Business Name | SAM TELLAWI MD PA
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 05/07/2019
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Provider Practice Location Address
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Address Line | 560 RIVERSIDE DR STE A206
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City | SALISBURY
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State | MD
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Zip | 21801-4704
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Country | US
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Telephone | 410-912-5640
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Fax |
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Provider Business Mailing Address
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Address Line | 7700 OLD BRANCH AVE SUITE B-102
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City | CLINTON
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State | MD
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Zip | 20735-1628
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Country | US
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Telephone | 301-856-1960
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Fax | 301-856-3206
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Authorized Official
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Title or Position | MANAGER
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Name | MARIA CORNMAN
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Credential |
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Telephone | 800-749-5191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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