Physician Compare National (NPI:1336455112)

HEALTHCARE PROVIDER: SAMAH O MOHIUDDIN MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1336455112
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0143462614
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20130813000279
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MOHIUDDIN
	Individual professional last name
Provider First Name	SAMAH
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	2008
	Individual professional's medical school graduation year
Primary Specialty	NEUROLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1101 ERIE E BLVD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 204
	Group Practice or individual's line 2 address
City	SYRACUSE
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	132101144
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	330157
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	SAMARITAN MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	331317
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	LEWIS COUNTY GENERAL HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	331309
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	RIVER HOSPITAL, INC
	Legal business name of hospital where individual professional provides service 3
Professional Accepts Medicare Assignment	Y