Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 267052 | MA |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 267052 | MA |
NPI | 1356634166 |
---|---|
Provider Name | Sami William Mardam-Bey |
First Address | Raleigh, NC 27604-0010 |
Second Address | Raleigh, NC 27610-1214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2011 |
Last Update Date | 09/03/2021 |