Provider Demographics
NPI:1831294305
Name:SAMUEL, HAROLD SUDHIR (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:SUDHIR
Last Name:SAMUEL
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 1:606 NORTH FIRST ST
Mailing Address - Street 2:SUITE G
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-2803
Mailing Address - Country:US
Mailing Address - Phone:704-983-1241
Mailing Address - Fax:704-550-5163
Practice Address - Street 1:606 N 1ST ST
Practice Address - Street 2:STE G
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3371
Practice Address - Country:US
Practice Address - Phone:704-983-1241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501082207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8974420Medicaid
G11210Medicare UPIN
NC8974420Medicaid