Issam F Damalouji MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

D0003077 Issued in MD

Legal business name

ISSAM F DAMALOUJI MD

Practice address

135 W Dares Beach Rd
Prince Frederick, MD 20678-3119

Phone

(410) 263-6638

Fax

(410) 268-6830

NPI assigned

Mar 15, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tracey L Haynes

Title

Billing Agent Ofc MGR

Phone

(410) 263-6638

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1326172248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3269",
            "city": "PRINCE FREDERICK",
            "state": "MD",
            "postal_code": "206782279",
            "telephone_number": "410-263-6638",
            "fax_number": "410-268-6830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 W DARES BEACH RD",
            "city": "PRINCE FREDERICK",
            "state": "MD",
            "postal_code": "206783119",
            "telephone_number": "410-263-6638",
            "fax_number": "410-268-6830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISSAM F DAMALOUJI MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HAYNES",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "BILLING AGENT OFC MGR",
        "authorized_official_telephone_number": "410-263-6638"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D0003077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Prince Frederick, MD
• Providers in Prince Frederick, MD by specialty
• Family Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.