Provider Demographics
NPI:1669403341
Name:ISMAILJEE, SAMEER BURMAWALA (MD)
Entity type:Individual
Prefix:
First Name:SAMEER
Middle Name:BURMAWALA
Last Name:ISMAILJEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 ALDERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2686
Mailing Address - Country:US
Mailing Address - Phone:937-620-2335
Mailing Address - Fax:
Practice Address - Street 1:310 ALDERWOOD DR
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-2686
Practice Address - Country:US
Practice Address - Phone:937-620-2335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35083321207RI0200X
TXV2379207RI0200X
MDD82137207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2672577Medicaid
OH2672577Medicaid
OHI56677Medicare UPIN