Provider Demographics
NPI:1194928861
Name:SAMIR R. AKRUK,M.D.,PC
Entity type:Organization
Organization Name:SAMIR R. AKRUK,M.D.,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:R
Authorized Official - Last Name:AKRUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PHD
Authorized Official - Phone:215-750-9999
Mailing Address - Street 1:1205 LANGHORNE NEWTOWN RD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1219
Mailing Address - Country:US
Mailing Address - Phone:215-750-9999
Mailing Address - Fax:215-750-9504
Practice Address - Street 1:1205 LANGHORNE NEWTOWN RD
Practice Address - Street 2:SUITE 312
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1219
Practice Address - Country:US
Practice Address - Phone:215-750-9999
Practice Address - Fax:215-750-9504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1964970OtherHIGHMARK BLUE SHIELD
PA1972548691OtherINDIVIDUAL NPI
PA1194928861OtherNPI TYPE2
PAMD039759LOtherSTSTE LIC
PAMD039759LOtherSTSTE LIC
PAB41739Medicare UPIN