Provider Demographics
NPI:1396701843
Name:SAMAD, IQBAL ABDUS (MD FRCP FCCP)
Entity type:Individual
Prefix:DR
First Name:IQBAL
Middle Name:ABDUS
Last Name:SAMAD
Suffix:
Gender:M
Credentials:MD FRCP FCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2148 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2668
Mailing Address - Country:US
Mailing Address - Phone:716-835-9866
Mailing Address - Fax:716-835-0026
Practice Address - Street 1:2148 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2668
Practice Address - Country:US
Practice Address - Phone:716-835-9866
Practice Address - Fax:716-835-0026
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105005207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00683358Medicaid
NY039391Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
NY00683358Medicaid