Provider Demographics
NPI:1285983684
Name:ABDUS SAMAD, MOHAMED ANWAR (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMED ANWAR
Middle Name:
Last Name:ABDUS SAMAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 S. WEST ST
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013
Mailing Address - Country:US
Mailing Address - Phone:717-245-2291
Mailing Address - Fax:
Practice Address - Street 1:380 SAINT CHARLES WAY
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-4647
Practice Address - Country:US
Practice Address - Phone:717-851-6040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD460130207RN0300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
1285983684OtherNPI
PA103453479Medicaid