Provider Demographics
NPI:1508983115
Name:SUBURBAN ORTHOPAEDIC,TOTAL JOINT AND SPORTS CLINIC,P.C.
Entity Type:Organization
Organization Name:SUBURBAN ORTHOPAEDIC,TOTAL JOINT AND SPORTS CLINIC,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:NAGUIB
Authorized Official - Last Name:AZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-292-7447
Mailing Address - Street 1:11701 LIVINGSTON RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-5104
Mailing Address - Country:US
Mailing Address - Phone:301-292-7447
Mailing Address - Fax:301-292-3278
Practice Address - Street 1:11701 LIVINGSTON RD
Practice Address - Street 2:SUITE 105
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-5104
Practice Address - Country:US
Practice Address - Phone:301-292-7447
Practice Address - Fax:301-292-3278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0022051207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD782111500Medicaid
037140Medicare PIN