Provider Demographics
NPI:1457316101
Name:AHDOOT, SAMANTHA W (MD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:W
Last Name:AHDOOT
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 1:6355 WALKER LANE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310
Mailing Address - Country:US
Mailing Address - Phone:703-924-2100
Mailing Address - Fax:703-924-9894
Practice Address - Street 1:6355 WALKER LANE
Practice Address - Street 2:SUITE 401
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310
Practice Address - Country:US
Practice Address - Phone:703-924-2100
Practice Address - Fax:703-924-9894
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234643208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
I25099Medicare UPIN