Provider Demographics
NPI:1669477386
Name:ICU PHYSICIANS, PC
Entity Type:Organization
Organization Name:ICU PHYSICIANS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-203-2232
Mailing Address - Street 1:PO BOX 441325
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20749-1325
Mailing Address - Country:US
Mailing Address - Phone:301-983-6656
Mailing Address - Fax:301-983-8110
Practice Address - Street 1:11711 LIVINGSTON RD
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-5151
Practice Address - Country:US
Practice Address - Phone:301-203-2232
Practice Address - Fax:301-203-2054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0026262207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD027462500Medicaid
DA4019OtherRR MEDICARE
DC7821OtherCAREFIRST OF DC
DC7821OtherCAREFIRST OF DC