Organization
SAM TELLAWI MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA CORNMAN (MANAGER)
(800) 749-5191
Entity
Organization
Contact information
Practice address
560 RIVERSIDE DR STE A206, SALISBURY, MD 21801-4704
(410) 912-5640
Mailing address
7700 OLD BRANCH AVE, SUITE B-102, CLINTON, MD 20735-1628
(301) 856-1960
(301) 856-3206
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
062048700
MEDICAL ASSISTANCE
DC
01
—
1104963990
MEDICAID
VA
01
—
248N
MEDICARE
MD
01
—
632104600
MEDICAL ASSISTANCE
MD
01
—
8556
CAREFIRST
MD
01
—
A618
CAREFIRST
DC
01
—
DN4447
RAILROAD MEDICARE
GA
01
—
G02093
MEDICARE
DC
Enumeration date
01/31/2007
Last updated
05/07/2019
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