Provider Demographics
NPI:1346270287
Name:SAMAAN, MAGED (MD)
Entity type:Individual
Prefix:
First Name:MAGED
Middle Name:
Last Name:SAMAAN
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 1:1638 OWEN DR
Mailing Address - Street 2:ATTN: MANAGED CARE PLANNING
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3424
Mailing Address - Country:US
Mailing Address - Phone:910-615-6949
Mailing Address - Fax:910-615-9761
Practice Address - Street 1:1638 OWEN DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3424
Practice Address - Country:US
Practice Address - Phone:910-615-7392
Practice Address - Fax:910-615-7633
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-00395207R00000X, 207RC0200X
NJ25MA08000600207R00000X
SC30482207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC304824Medicaid
SCAA27078989OtherSC MEDICARE PTAN
SCGP4840OtherMEDICAID GROUP
SCGP39112OtherMEDICAID GROUP
SCGP4306OtherMEDICAID GROUP
SC304824Medicaid
SCAA27077153Medicare PIN
SCGP39112OtherMEDICAID GROUP