Provider Demographics
NPI:1841290327
Name:SAMORODIN, CHARLES STEVEN (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:STEVEN
Last Name:SAMORODIN
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 1:54 SCOTT ADAM RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COCKEYSVILLE HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21030-3216
Mailing Address - Country:US
Mailing Address - Phone:410-628-2266
Mailing Address - Fax:410-628-2653
Practice Address - Street 1:54 SCOTT ADAM RD
Practice Address - Street 2:SUITE 201
Practice Address - City:COCKEYSVILLE HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21030-3216
Practice Address - Country:US
Practice Address - Phone:410-628-2266
Practice Address - Fax:410-628-2653
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-27
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD12936207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB67190Medicare UPIN
MD7273Medicare ID - Type Unspecified
MDB525Medicare PIN