Provider Demographics
NPI:1891781118
Name:DRS MUNIR & SAMAD
Entity Type:Organization
Organization Name:DRS MUNIR & SAMAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:MUNIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-743-7657
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:99 BALDWIN BLVD
Mailing Address - City:SHAMOKIN DAM
Mailing Address - State:PA
Mailing Address - Zip Code:17876
Mailing Address - Country:US
Mailing Address - Phone:570-743-7657
Mailing Address - Fax:570-743-0047
Practice Address - Street 1:99 BALDWIN BLVD
Practice Address - Street 2:
Practice Address - City:SHAMOKIN DAM
Practice Address - State:PA
Practice Address - Zip Code:17876
Practice Address - Country:US
Practice Address - Phone:570-743-7657
Practice Address - Fax:570-743-0047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034193L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006883990001Medicaid
C30847Medicare UPIN
PA0006883990001Medicaid