Basic Information
Provider Information
NPI: 1639662034
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JABBOUR
FirstName: SAMER
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7503 SURRATTS RD
Address2:  
City: CLINTON
State: MD
PostalCode: 207353358
CountryCode: US
TelephoneNumber: 3018688000
FaxNumber:  
Practice Location
Address1: 7503 SURRATTS RD
Address2:  
City: CLINTON
State: MD
PostalCode: 207353358
CountryCode: US
TelephoneNumber: 1301868800
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/11/2018
LastUpdateDate: 01/25/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/25/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208200000XD93306MDY Allopathic & Osteopathic PhysiciansPlastic Surgery 

No ID Information.


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