# SAM TELLAWI MD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104963990
- **Authorized official:** MARIA CORNMAN (MANAGER)
- **Authorized official phone:** (800) 749-5191

## Contact information

- **Practice address:** 560 RIVERSIDE DR STE A206, SALISBURY, MD 21801-4704
- **Practice address phone:** (410) 912-5640
- **Mailing address:** 7700 OLD BRANCH AVE, SUITE B-102, CLINTON, MD 20735-1628
- **Mailing address phone:** (301) 856-1960
- **Mailing address fax:** (301) 856-3206

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RG0100X | Gastroenterology Physician | — | NULL | Yes |
| 207RG0100X | Gastroenterology Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/31/2007
- **Last updated:** 05/07/2019