Provider Demographics
NPI:1801816947
Name:NAFICY, SAM (MD, PS)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:
Last Name:NAFICY
Suffix:
Gender:M
Credentials:MD, PS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 112TH AVE NE STE 150
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4570
Mailing Address - Country:US
Mailing Address - Phone:425-450-0880
Mailing Address - Fax:425-450-0883
Practice Address - Street 1:1110 112TH AVE NE STE 150
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4570
Practice Address - Country:US
Practice Address - Phone:425-450-0880
Practice Address - Fax:425-450-0883
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037251174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAH01382Medicare UPIN
WAG8801148Medicare PIN