Provider Demographics
NPI:1851472294
Name:SHUREIH, SAMIR FAHMI (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:FAHMI
Last Name:SHUREIH
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 1:11815 FAR EDGE PATH
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-4371
Mailing Address - Country:US
Mailing Address - Phone:410-243-3035
Mailing Address - Fax:410-997-0264
Practice Address - Street 1:5300 DORSEY HALL DR STE 102
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7819
Practice Address - Country:US
Practice Address - Phone:410-243-3035
Practice Address - Fax:410-997-0264
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD21848174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK982GY97Medicare ID - Type Unspecified
MDB70279Medicare UPIN