Provider Demographics
NPI:1508915935
Name:SAMTANI, PUSHMA RAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:PUSHMA
Middle Name:RAJ
Last Name:SAMTANI
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 1:9521 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-4635
Mailing Address - Country:US
Mailing Address - Phone:301-299-1165
Mailing Address - Fax:
Practice Address - Street 1:9131 PISCATAWAY RD
Practice Address - Street 2:SUITE 280
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2508
Practice Address - Country:US
Practice Address - Phone:301-868-3003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD28999207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD8143794OtherUNITED HEALTHCARE ID
MD7428OtherBLUE CROSS BLUE SHIELD
MD7428OtherBLUE CROSS BLUE SHIELD
DC187591Medicare ID - Type Unspecified
MD8143794OtherUNITED HEALTHCARE ID