MEDICARE: CHARLES STEVEN SAMORODIN 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	207N00000X	Dermatology Physician	D12936	MD

General Provider Information

NPI Number	:	1841290327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES STEVEN SAMORODIN MD

Provider Business Mailing Address
First Line	:	54 SCOTT ADAM RD
Second Line	:	SUITE 201
City	:	COCKEYSVILLE HUNT VALLEY
State	:	MD
Zip	:	21030-3216
Country	:	US
Telephone Number	:	410-628-2266
Fax Number	:	410-628-2653

Provider Business Practice Location Address
First Line	:	54 SCOTT ADAM RD
Second Line	:	SUITE 201
City	:	COCKEYSVILLE HUNT VALLEY
State	:	MD
Zip	:	21030-3216
Country	:	US
Telephone Number	:	410-628-2266
Fax Number	:	410-628-2653

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

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	11/08/2007

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