Provider Demographics
NPI:1619235421
Name:MAJMUDAR, SAMIR SUVAS
Entity Type:Individual
Prefix:
First Name:SAMIR
Middle Name:SUVAS
Last Name:MAJMUDAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34503 9TH AVE S STE 230
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8726
Mailing Address - Country:US
Mailing Address - Phone:253-838-3103
Mailing Address - Fax:253-838-7134
Practice Address - Street 1:34503 9TH AVE S STE 230
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8726
Practice Address - Country:US
Practice Address - Phone:253-838-3103
Practice Address - Fax:253-838-7134
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1153207R00000X
390200000X
WAOP61072733207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2137681Medicaid