Provider Demographics
NPI:1295767267
Name:SAMUELS, CAROLINE (MD)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6908 NEVIS RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-4643
Mailing Address - Country:US
Mailing Address - Phone:301-229-6568
Mailing Address - Fax:
Practice Address - Street 1:2440 M ST NW
Practice Address - Street 2:SUITE 510
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1404
Practice Address - Country:US
Practice Address - Phone:202-822-0622
Practice Address - Fax:202-466-4776
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD35275207R00000X
MDD0035275207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B94356Medicare UPIN