Provider Demographics
NPI:1528184553
Name:SROUJI, SAMIR J (MD)
Entity Type:Individual
Prefix:
First Name:SAMIR
Middle Name:J
Last Name:SROUJI
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 1:3438 TRINDLE RD
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-4450
Mailing Address - Country:US
Mailing Address - Phone:717-763-4888
Mailing Address - Fax:717-763-1749
Practice Address - Street 1:3438 TRINDLE RD
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4450
Practice Address - Country:US
Practice Address - Phone:717-763-4888
Practice Address - Fax:717-763-1749
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017849E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB35050Medicare UPIN