=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275582389
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMINA YOUSUF M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2006
-----------------------------------------------------
Last Update Date | 05/13/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 142 HIGHLAND DR
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24266-4636
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-889-0433
-----------------------------------------------------
Fax | 276-889-5537
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 142 HIGHLAND DR
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24266-4636
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 276-889-0433
-----------------------------------------------------
Fax | 276-889-5537
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 0101054913
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------