Provider Demographics
NPI:1275563520
Name:ISKANDAR, SAMY R (MD)
Entity Type:Individual
Prefix:
First Name:SAMY
Middle Name:R
Last Name:ISKANDAR
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:PO BOX 743294
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3294
Mailing Address - Country:US
Mailing Address - Phone:864-516-1190
Mailing Address - Fax:864-516-1191
Practice Address - Street 1:2 MAPLE TREE CT STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4069
Practice Address - Country:US
Practice Address - Phone:864-516-1190
Practice Address - Fax:864-516-1191
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27596207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC275963Medicaid
SC2027596Medicaid
SCH082203365Medicare PIN
SCH08220Medicare UPIN
SCH082207265Medicare ID - Type Unspecified
SCH082207265Medicare ID - Type Unspecified