Provider Demographics
NPI:1477547693
Name:SAMAD, NAEEM (MD)
Entity Type:Individual
Prefix:DR
First Name:NAEEM
Middle Name:
Last Name:SAMAD
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 1:1729 BURRSTONE ROAD
Mailing Address - Street 2:SLOCOM DICKSON MEDICAL GROUP PLLC
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413
Mailing Address - Country:US
Mailing Address - Phone:315-798-1580
Mailing Address - Fax:315-798-1583
Practice Address - Street 1:1729 BURRSTONE RD
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-1001
Practice Address - Country:US
Practice Address - Phone:315-798-1700
Practice Address - Fax:315-798-1707
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY154023208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00819172Medicaid
B82441Medicare UPIN
RA0947Medicare PIN