Individual
SAMIR GAUTAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1830 E MONUMENT ST STE 416, BALTIMORE, MD 21287-0020
(410) 955-5268
(410) 367-2258
Mailing address
6201 GREENLEIGH AVE, MIDDLE RIVER, MD 21220-2004
(410) 933-6423
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
23889
MS
207RN0300X
Nephrology Physician
Primary
D77622
MD
207RN0300X
Nephrology Physician
MD20786
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04931327
—
MS
05
—
2434187
—
LA
Enumeration date
08/24/2009
Last updated
05/25/2021
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