=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790866168
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAMIR F. SHUREIH M.D. P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 E 31ST ST
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21218-3901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-243-3035
-----------------------------------------------------
Fax | 410-243-7253
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 E 31ST ST
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21218-3901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-243-3035
-----------------------------------------------------
Fax | 410-243-7253
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. SAMIR FAHMI SHUREIH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 410-243-3035
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | D21848
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------