Provider Demographics
NPI:1134285208
Name:SAMANEZ, ENRIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:
Last Name:SAMANEZ
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 1:239 MURTHA ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-8602
Mailing Address - Country:US
Mailing Address - Phone:571-233-7373
Mailing Address - Fax:703-567-0101
Practice Address - Street 1:8909 OLD BRANCH AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2528
Practice Address - Country:US
Practice Address - Phone:301-868-7780
Practice Address - Fax:301-868-9098
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053066207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6875-0047OtherBLUE CROSS BLUE SHIELD
P00249850Medicare ID - Type UnspecifiedRAILROAD MEDICARE GROUP #
MD409SMedicare ID - Type UnspecifiedINDIVIDUAL PRACTICE
MD6875-0047OtherBLUE CROSS BLUE SHIELD
DC491970Medicare ID - Type UnspecifiedDC METRO INDIVIDUAL #
MD016167C43Medicare ID - Type UnspecifiedGROUP #