1750796587 NPI number — SAM SKARIAH MD

Table of content: SAM SKARIAH MD (NPI 1750796587)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750796587 NPI number — SAM SKARIAH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SKARIAH
Provider First Name:
SAM
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SKARIAH
Provider Other First Name:
SAM
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1750796587
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 OLD YORK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABINGTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19001-3720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-481-2191
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2545 SCHOENERSVILLE RD STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18017-7300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-884-5733
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/01/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  MD461283 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X , with the licence number: MD461283 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)