Provider Demographics
NPI:1801994207
Name:ELGENDY, SAMAR S (MD)
Entity type:Individual
Prefix:DR
First Name:SAMAR
Middle Name:S
Last Name:ELGENDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1463 PAMALEE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-3974
Mailing Address - Country:US
Mailing Address - Phone:910-482-3000
Mailing Address - Fax:910-482-0397
Practice Address - Street 1:1463 PAMALEE DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-3974
Practice Address - Country:US
Practice Address - Phone:910-482-3000
Practice Address - Fax:910-482-0397
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2006-01158207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5905146Medicaid
NC2057918Medicare PIN
NCPENDINGMedicare UPIN
NC5905146Medicaid