=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609849900
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMINA ISMAIL MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2006
-----------------------------------------------------
Last Update Date | 01/07/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7720 CHAPEL HILL RD
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27607-4956
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-655-5020
-----------------------------------------------------
Fax | 919-324-6683
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 309 MALVERN HILL LN
-----------------------------------------------------
City | MORRISVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27560-9722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-655-5020
-----------------------------------------------------
Fax | 919-324-6683
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 01518
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------