Provider Demographics
NPI:1033400783
Name:KANNARKATT, SAMIRA (MD)
Entity Type:Individual
Prefix:
First Name:SAMIRA
Middle Name:
Last Name:KANNARKATT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SAMIRA
Other - Middle Name:
Other - Last Name:ALI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-6798
Practice Address - Street 1:2050 S QUEEN ST STE 100
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4829
Practice Address - Country:US
Practice Address - Phone:717-812-4240
Practice Address - Fax:717-848-5520
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301104689208000000X
PAMD462666208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics