Provider Demographics
NPI:1003833781
Name:PANDIT, SAMEER A (MD)
Entity Type:Individual
Prefix:
First Name:SAMEER
Middle Name:A
Last Name:PANDIT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-4054
Mailing Address - Country:US
Mailing Address - Phone:540-891-5764
Mailing Address - Fax:540-891-5769
Practice Address - Street 1:2121 MEDICAL PARK DRIVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902
Practice Address - Country:US
Practice Address - Phone:301-681-3003
Practice Address - Fax:301-681-5868
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00597652085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD60234801OtherBLUE SHIELD
MD402134701Medicaid
DC80430035OtherBLUE SHIELD
MD012762C85Medicare PIN
DC80430035OtherBLUE SHIELD
H85688Medicare UPIN
MD012763D05Medicare PIN
P00093978Medicare PIN
MD402134701Medicaid
P00081399Medicare PIN