MEDICARE: SAMEERA NAUREEN IMTIAZ

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	363A00000X	Physician Assistant
2	363A00000X	Physician Assistant	028307	NY
3	363A00000X	Physician Assistant	PA66604	CA
4	363AM0700X	Medical Physician Assistant	C0006482	MD
5	363A00000X	Physician Assistant	C0006482	MD

General Provider Information

NPI Number	:	1174047625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMEERA NAUREEN IMTIAZ

Provider Business Mailing Address
First Line	:	11120 NEW HAMPSHIRE AVE
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-2633
Country	:	US
Telephone Number	:	301-681-7237
Fax Number	:

Provider Business Practice Location Address
First Line	:	11120 NEW HAMPSHIRE AVE
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-2633
Country	:	US
Telephone Number	:	301-681-7237
Fax Number	:

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

Provider Enumeration Date	:	07/26/2017
Last Update Date	:	03/24/2026

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Directions to “ SAMEERA NAUREEN IMTIAZ ” Practice Location

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