Individual
MAGED SAMAAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1638 OWEN DR, FAYETTEVILLE, NC 28304-3424
(910) 615-7392
(910) 615-7633
Mailing address
1638 OWEN DR, ATTN: MANAGED CARE PLANNING, FAYETTEVILLE, NC 28304-3424
(910) 615-6949
(910) 615-9761
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2008-00395
NC
207R00000X
Internal Medicine Physician
25MA08000600
NJ
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
2008-00395
NC
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
30482
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
304824
—
SC
01
—
AA27078989
SC MEDICARE PTAN
SC
01
—
GP39112
MEDICAID GROUP
SC
01
—
GP4306
MEDICAID GROUP
SC
01
—
GP4840
MEDICAID GROUP
SC
Enumeration date
07/04/2006
Last updated
02/08/2022
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