Provider Demographics
NPI:1699294405
Name:MEFTAH, SAM SAHEL (CSA)
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:SAHEL
Last Name:MEFTAH
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5408 BRADLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-1002
Mailing Address - Country:US
Mailing Address - Phone:703-774-8767
Mailing Address - Fax:
Practice Address - Street 1:5408 BRADLEY BLVD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1002
Practice Address - Country:US
Practice Address - Phone:703-774-8767
Practice Address - Fax:703-774-8767
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant