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General NPI Number Information
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NPI Number | 1518245281
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Entity Type | Individual
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Provider Name | SAMAR VANAIK M.D
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Gender | Male
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Dates
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Enumeration Date | 07/29/2011
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Last Update Date | 06/08/2015
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Provider Practice Location Address
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Address Line | 5501 OLD YORK RD 363
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City | PHILADELPHIA
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State | PA
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Zip | 19141-3018
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Country | US
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Telephone | 215-456-8349
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Fax |
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Provider Business Mailing Address
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Address Line | 3670 WOODWARD AVENUE APT 406
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City | DETROIT
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State | MI
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Zip | 48201
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Country | US
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Telephone | 248-795-9083
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 4301098677
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License Number State | MI
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