Provider Demographics
NPI:1114073335
Name:SAMIA, MARK A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:SAMIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2731 CAPITAL BLVD # B
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-1509
Mailing Address - Country:US
Mailing Address - Phone:919-878-4647
Mailing Address - Fax:919-878-1541
Practice Address - Street 1:2731 CAPITAL BLVD # B
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1509
Practice Address - Country:US
Practice Address - Phone:919-878-4647
Practice Address - Fax:919-878-1541
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC34453208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice