Provider Demographics
NPI:1609849900
Name:ISMAIL, SAMINA (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMINA
Middle Name:
Last Name:ISMAIL
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 1:309 MALVERN HILL LN
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-9722
Mailing Address - Country:US
Mailing Address - Phone:919-655-5020
Mailing Address - Fax:919-324-6683
Practice Address - Street 1:7720 CHAPEL HILL RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-4956
Practice Address - Country:US
Practice Address - Phone:919-655-5020
Practice Address - Fax:919-324-6683
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01518174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900025Medicaid
NCNC8968B761Medicare PIN
NC5900025Medicaid