Provider Demographics
NPI:1962411561
Name:CROFF, SAMUEL JR (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:CROFF
Suffix:JR
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 1:7450 ALBERT RD FL 3
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-3035
Mailing Address - Country:US
Mailing Address - Phone:301-888-2233
Mailing Address - Fax:
Practice Address - Street 1:1458 ADDISON RD S
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-4413
Practice Address - Country:US
Practice Address - Phone:301-324-1500
Practice Address - Fax:301-324-6405
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0058177207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD437105400Medicaid
MD437105400Medicaid
001079G75Medicare ID - Type Unspecified