MEDICARE: DR. ENRIQUE SAMANEZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	D0053066	MD
2	207RP1001X	Pulmonary Disease Physician	D0053066	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6875-0047	OTHER	MD	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1134285208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ENRIQUE SAMANEZ M.D.

Provider Business Mailing Address
First Line	:	239 MURTHA ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22304-8602
Country	:	US
Telephone Number	:	571-233-7373
Fax Number	:	703-567-0101

Provider Business Practice Location Address
First Line	:	8909 OLD BRANCH AVE
Second Line	:
City	:	CLINTON
State	:	MD
Zip	:	20735-2528
Country	:	US
Telephone Number	:	301-868-7780
Fax Number	:	301-868-9098

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2006
Last Update Date	:	12/06/2007

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