Provider Demographics
NPI:1396703229
Name:AL-SAMARRAI, SADIQ H (MD)
Entity type:Individual
Prefix:DR
First Name:SADIQ
Middle Name:H
Last Name:AL-SAMARRAI
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 1:10611 HICKORY PT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-4069
Mailing Address - Country:US
Mailing Address - Phone:443-481-6549
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:201 DEFENSE HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-8943
Practice Address - Country:US
Practice Address - Phone:443-481-6549
Practice Address - Fax:443-481-6515
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2253912084P0800X
MDD699772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD3926Medicare PIN
NYRB2502Medicare PIN
NYDD3937Medicare PIN
NYH74715Medicare UPIN