Provider Demographics
NPI:1396235131
Name:DHRUV, SAMYAK HITESHKUMAR (MBBS , MD)
Entity type:Individual
Prefix:MR
First Name:SAMYAK
Middle Name:HITESHKUMAR
Last Name:DHRUV
Suffix:
Gender:M
Credentials:MBBS , MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25500 POINT LOOKOUT RD
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-2015
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:475 SEAVIEW AVENUE,
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305
Practice Address - Country:US
Practice Address - Phone:917-182-2690
Practice Address - Fax:718-226-1347
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-17
Last Update Date:2021-11-29
Deactivation Date:2019-01-09
Deactivation Code:
Reactivation Date:2019-02-18
Provider Licenses
StateLicense IDTaxonomies
390200000X
MDD0090889207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program