Provider Demographics
NPI:1134521636
Name:RAMADAN-NASSAR, SAMAH N (PA)
Entity type:Individual
Prefix:
First Name:SAMAH
Middle Name:N
Last Name:RAMADAN-NASSAR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SAMAH
Other - Middle Name:
Other - Last Name:RAMADAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:10207 RUFFIAN LN
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:MD
Mailing Address - Zip Code:21811-2734
Mailing Address - Country:US
Mailing Address - Phone:443-614-9588
Mailing Address - Fax:
Practice Address - Street 1:100 E CARROLL ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5422
Practice Address - Country:US
Practice Address - Phone:410-543-7536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC05519363A00000X
PAMA060662363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant