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General NPI Number Information
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NPI Number | 1396736971
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Entity Type | Individual
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Provider Name | ALBERT D SAM II MD
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Gender | Male
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 1800 N BEAUREGARD ST STE 50
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City | ALEXANDRIA
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State | VA
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Zip | 22311-1735
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Country | US
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Telephone | 703-205-7330
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Fax | 703-205-7331
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Provider Business Mailing Address
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Address Line | PO BOX 37174
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City | BALTIMORE
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State | MD
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Zip | 21297-3174
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Country | US
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Telephone | 571-423-5699
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Fax | 571-423-5698
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 15157R
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 55673
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 0101268276
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License Number State | VA
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