Provider Demographics
NPI:1366903049
Name:AL GHAZAWI, SAMIR SADIK SHAREEF (MD)
Entity type:Individual
Prefix:
First Name:SAMIR
Middle Name:SADIK SHAREEF
Last Name:AL GHAZAWI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:ECU HEALTH MEDICAL CENTER
Mailing Address - Street 2:NORTH TOWER 3RD FLOOR, ROOM 086
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834
Mailing Address - Country:US
Mailing Address - Phone:252-847-9858
Mailing Address - Fax:252-847-7620
Practice Address - Street 1:2100 STANTONSBURG RD FL 3
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-2818
Practice Address - Country:US
Practice Address - Phone:252-847-9858
Practice Address - Fax:252-847-7620
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC2023-004602084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program