Provider Demographics
NPI:1275560575
Name:STOLERU, SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:STOLERU
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 1:3553 16TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-3041
Mailing Address - Country:US
Mailing Address - Phone:202-387-8900
Mailing Address - Fax:202-328-0565
Practice Address - Street 1:3553 16TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-3041
Practice Address - Country:US
Practice Address - Phone:202-387-8900
Practice Address - Fax:202-328-0565
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0029171207W00000X
DCMD006852207W00000X
VA0101037838207W00000X
FLME80732207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0561739OtherAETNA
DC022453100Medicaid
0002OtherCAREFIRST BLUE SHIELD
20914OtherMDIPA
VA6302831Medicaid
10225502OtherAMERIGROUP
MD410441200Medicaid
MD410441201Medicaid
6566OtherDAVIS VISION
0046333OtherCIGNA
DC191850Medicare PIN
0046333OtherCIGNA
MD410441201Medicaid