Provider Demographics
NPI:1689849895
Name:BHASIN, SAMIR
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:
Last Name:BHASIN
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:SAMIR
Other - Middle Name:
Other - Last Name:BHASIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:331 OAK MANOR DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5548
Mailing Address - Country:US
Mailing Address - Phone:410-768-0700
Mailing Address - Fax:410-768-1143
Practice Address - Street 1:331 OAK MANOR DR
Practice Address - Street 2:SUITE 203
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5548
Practice Address - Country:US
Practice Address - Phone:410-768-0700
Practice Address - Fax:410-768-1143
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC148994208000000X
MDH72041208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics