Provider Demographics
NPI:1588729248
Name:ELLAHHAM, SAMER HELMI (MD)
Entity type:Individual
Prefix:DR
First Name:SAMER
Middle Name:HELMI
Last Name:ELLAHHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3701 S GEORGE MASON DR
Mailing Address - Street 2:SUITE C-1 NORTH
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-3758
Mailing Address - Country:US
Mailing Address - Phone:703-379-9202
Mailing Address - Fax:703-379-9204
Practice Address - Street 1:3701 S GEORGE MASON DR
Practice Address - Street 2:SUITE C1 NORTH
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-3758
Practice Address - Country:US
Practice Address - Phone:703-379-9202
Practice Address - Fax:703-379-9204
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101043972207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5867541Medicaid
VAG00567Medicare ID - Type UnspecifiedSOLO PRACTITIONER
VAE36530Medicare UPIN