MEDICARE: MOHAMMAD ABDUL SAMAD 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	207R00000X	Internal Medicine Physician	MD034317L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962516997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOHAMMAD ABDUL SAMAD MD

Provider Business Mailing Address
First Line	:	PO BOX 427
Second Line	:	99 BALDWIN BLVD
City	:	SHAMOKIN DAM
State	:	PA
Zip	:	17876
Country	:	US
Telephone Number	:	570-743-7657
Fax Number	:	570-743-0047

Provider Business Practice Location Address
First Line	:	99 BALDWIN BLVD
Second Line	:
City	:	SHAMOKIN DAM
State	:	PA
Zip	:	17876
Country	:	US
Telephone Number	:	570-743-7657
Fax Number	:	570-743-0047

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

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	07/08/2007

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