Provider Demographics
NPI:1194766899
Name:ATAYA, SAMIR (MD)
Entity type:Individual
Prefix:
First Name:SAMIR
Middle Name:
Last Name:ATAYA
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 1:2055 HOSPITAL DR
Mailing Address - Street 2:STE 200
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103
Mailing Address - Country:US
Mailing Address - Phone:513-735-1701
Mailing Address - Fax:513-735-8995
Practice Address - Street 1:2055 HOSPITAL DR
Practice Address - Street 2:STE 200
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103
Practice Address - Country:US
Practice Address - Phone:513-735-1701
Practice Address - Fax:513-735-8995
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-082959207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2641154Medicaid
OH35-082959OtherLICENSE
OH2641154Medicaid