Provider Demographics
NPI:1639132848
Name:CHEIKH, ISSAM E (MD)
Entity Type:Individual
Prefix:DR
First Name:ISSAM
Middle Name:E
Last Name:CHEIKH
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 1:200 E 33RD ST
Mailing Address - Street 2:STE 512
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-3322
Mailing Address - Country:US
Mailing Address - Phone:410-554-4511
Mailing Address - Fax:
Practice Address - Street 1:200 E 33RD ST
Practice Address - Street 2:STE 512
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-3322
Practice Address - Country:US
Practice Address - Phone:410-554-4511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0014748207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD118501200Medicaid
MD306530-03 & 04OtherBLUE CROSS/BLUE SHIELD
MD460002938Medicare PIN
MD306530-03 & 04OtherBLUE CROSS/BLUE SHIELD
B68887Medicare UPIN