Provider Demographics
NPI:1275582389
Name:YOUSUF, SAMINA (MD)
Entity Type:Individual
Prefix:
First Name:SAMINA
Middle Name:
Last Name:YOUSUF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:VA
Mailing Address - Zip Code:24266-4636
Mailing Address - Country:US
Mailing Address - Phone:276-889-0433
Mailing Address - Fax:276-889-5537
Practice Address - Street 1:142 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266-4636
Practice Address - Country:US
Practice Address - Phone:276-889-0433
Practice Address - Fax:276-889-5537
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054913207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA382745OtherBLUE CROSS
VA005850533Medicaid
VA176423OtherBLUE CROSS
VA174348OtherBLUE CROSS
VAVA0101OtherJOHN DEERE
VA010087000OtherFEDERAL BLACK LUNG
VA010172632Medicaid
VA005880335Medicaid
VA289808OtherMAMSI
VA010172632Medicaid
VA174348OtherBLUE CROSS
VA005880335Medicaid