Provider Demographics
NPI:1306867510
Name:ALAISH, SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:ALAISH
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:PO BOX 64226
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4742
Mailing Address - Country:US
Mailing Address - Phone:410-328-6897
Mailing Address - Fax:410-328-2109
Practice Address - Street 1:1800 ORLEANS ST RM 7337
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0010
Practice Address - Country:US
Practice Address - Phone:410-955-2960
Practice Address - Fax:410-502-5314
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0059192208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4000027700Medicaid
MD270875OtherMDIPA
MD0079OtherCAREFIRST REGIONAL
MD79998OtherGEISINGER
MD1701615OtherUNITED HLTHCARE
MD1935825OtherUNITED HLTHCARE NATIONAL
MD227409OtherKAISER
MD61647401OtherBLUE SHIELD
MD79998OtherGEISINGER
MD1935825OtherUNITED HLTHCARE NATIONAL