Basic Information
| Provider Information | |||||||||
| NPI: | 1174268411 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOYAN | ||||||||
| FirstName: | SAMIAT | ||||||||
| MiddleName: | ADEBUKOLA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3234 THAMES LN | ||||||||
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| City: | LAUREL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207246129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107200871 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2002 MEDICAL PKWY | ||||||||
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| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214013046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434811000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2022 | ||||||||
| LastUpdateDate: | 06/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | R227416 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.