Provider Demographics
NPI:1851435127
Name:SAM-AGUDU, NADIA ADJOA (MD)
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:ADJOA
Last Name:SAM-AGUDU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NADIA
Other - Middle Name:ADJOA
Other - Last Name:SAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 62063
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-2063
Mailing Address - Country:US
Mailing Address - Phone:410-706-5181
Mailing Address - Fax:410-706-5103
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-6749
Practice Address - Fax:410-328-7305
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN473662080P0208X
ND110262080P0208X
MDD722742080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases