=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225042468
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMIR N SEMINE M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 825 WASHINGTON ST SUITE 215
-----------------------------------------------------
City | NORWOOD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02062-3441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-762-5595
-----------------------------------------------------
Fax | 781-762-9966
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 688
-----------------------------------------------------
City | NORWOOD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02062-0688
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-762-8010
-----------------------------------------------------
Fax | 781-762-7753
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 55959
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------