MEDICARE: ISSAM F DAMALOUJI 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	207Q00000X	Family Medicine Physician	D0003077	MD

General Provider Information

NPI Number	:	1326172248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISSAM F DAMALOUJI MD

Provider Business Mailing Address
First Line	:	PO BOX 3269
Second Line	:
City	:	PRINCE FREDERICK
State	:	MD
Zip	:	20678-2279
Country	:	US
Telephone Number	:	410-263-6638
Fax Number	:	410-268-6830

Provider Business Practice Location Address
First Line	:	135 W DARES BEACH RD
Second Line	:
City	:	PRINCE FREDERICK
State	:	MD
Zip	:	20678-3119
Country	:	US
Telephone Number	:	410-263-6638
Fax Number	:	410-268-6830

Authorized Official
Title or Position	:	BILLING AGENT OFC MGR
Name	:	TRACEY L HAYNES
Credential	:
Telephone Number	:	410-263-6638

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	08/22/2020

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