Provider Demographics
NPI:1679531388
Name:ISKANDER, SAMIR S (MD)
Entity type:Individual
Prefix:
First Name:SAMIR
Middle Name:S
Last Name:ISKANDER
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:L-3549
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43260-0001
Mailing Address - Country:US
Mailing Address - Phone:740-383-7927
Mailing Address - Fax:740-383-7942
Practice Address - Street 1:1040 DELAWARE AVENUE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43301-1814
Practice Address - Country:US
Practice Address - Phone:740-383-8047
Practice Address - Fax:740-383-7942
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.086009208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
311098079OtherTAX ID
P00229194OtherTRAVELERS MEDICARE
OH000000361453OtherANTHEM
OH2552036Medicaid
2518996OtherUHC
311098079OtherCIGNA
353077OtherSUBMITTER NO
311098079OtherPPO NEXT
4155312OtherPALMETTO MEDICARE
7811672OtherAETNA
4155312OtherPALMETTO MEDICARE
OH000000361453OtherANTHEM
OH4155312Medicare ID - Type Unspecified