Basic Information
| Provider Information | |||||||||
| NPI: | 1760436505 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAMUEL | ||||||||
| FirstName: | RICHARD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 803 RUSSELL AVE | ||||||||
| Address2: | SUITE #1 | ||||||||
| City: | GAITHERSBURG | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208793584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018690700 | ||||||||
| FaxNumber: | 3019481751 | ||||||||
| Practice Location | |||||||||
| Address1: | 7610 CARROLL AVE STE 410 | ||||||||
| Address2: | |||||||||
| City: | TAKOMA PARK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209126321 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3016083833 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 07/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 0101052355 | VA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | D47095 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.