Provider Demographics
NPI:1679778658
Name:AHUJA, SAMIR KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:KUMAR
Last Name:AHUJA
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 1:74 THOMAS JOHNSON DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4501
Mailing Address - Country:US
Mailing Address - Phone:301-694-9033
Mailing Address - Fax:301-694-6204
Practice Address - Street 1:74 THOMAS JOHNSON DR
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702
Practice Address - Country:US
Practice Address - Phone:301-694-9033
Practice Address - Fax:301-694-6204
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD67505207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
P02147870OtherRAILROAD MEDICARE
4512429OtherCIGNA
7468287OtherAETNA
1459-0014OtherCAREFIRST
MD416960300Medicaid
696095OtherMEDICARE
G92169Medicare UPIN