Provider Demographics
NPI:1699773853
Name:SAMII, SIAMAK (MD)
Entity type:Individual
Prefix:
First Name:SIAMAK
Middle Name:
Last Name:SAMII
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 1:15 SHADOW LN
Mailing Address - Street 2:
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317-9335
Mailing Address - Country:US
Mailing Address - Phone:610-388-2547
Mailing Address - Fax:
Practice Address - Street 1:4745 OGLETOWN STANTON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2067
Practice Address - Country:US
Practice Address - Phone:302-454-9011
Practice Address - Fax:302-454-9016
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10T00362174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000096601Medicaid
DE0000096601Medicaid
DESA123380Medicare PIN