MEDICARE: SUJANA SAMALA MD

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	200400254	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1424N	OTHER	NC	BCBS OF NC
2	191320	OTHER	NC	MEDCOST
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326061342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUJANA SAMALA MD

Provider Business Mailing Address
First Line	:	1000 CRESCENT GREEN DRIVE
Second Line	:	SUITE 102
City	:	CARY
State	:	NC
Zip	:	27518-8116
Country	:	US
Telephone Number	:	919-816-4948
Fax Number	:	919-233-7685

Provider Business Practice Location Address
First Line	:	1000 CRESCENT GREEN DRIVE
Second Line	:	SUITE 102
City	:	CARY
State	:	NC
Zip	:	27518-8116
Country	:	US
Telephone Number	:	919-816-4948
Fax Number	:	919-233-7685

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	11/19/2010

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Directions to “ SUJANA SAMALA MD” Practice Location

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