Provider Demographics
NPI:1790866168
Name:SAMIR F. SHUREIH M.D. P.A.
Entity Type:Organization
Organization Name:SAMIR F. SHUREIH M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:FAHMI
Authorized Official - Last Name:SHUREIH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-243-3035
Mailing Address - Street 1:10 E 31ST ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-3901
Mailing Address - Country:US
Mailing Address - Phone:410-243-3035
Mailing Address - Fax:410-243-7253
Practice Address - Street 1:10 E 31ST ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-3901
Practice Address - Country:US
Practice Address - Phone:410-243-3035
Practice Address - Fax:410-243-7253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD21848261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK982GY97Medicare ID - Type Unspecified
MDB70279Medicare UPIN