Provider Demographics
NPI:1154620151
Name:SAMS, TERRENCE
Entity type:Individual
Prefix:MR
First Name:TERRENCE
Middle Name:
Last Name:SAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3316 VALLEY FOREST DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-9400
Mailing Address - Country:US
Mailing Address - Phone:240-418-1743
Mailing Address - Fax:
Practice Address - Street 1:3316 VALLEY FOREST DR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-9400
Practice Address - Country:US
Practice Address - Phone:240-418-1743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD246ZC0007X246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant