Provider Demographics
NPI:1346206661
Name:SAMAHA, MICHEL R (MD)
Entity type:Individual
Prefix:DR
First Name:MICHEL
Middle Name:R
Last Name:SAMAHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:R
Other - Last Name:SAMAHA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:39 W CLARKE AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1839
Mailing Address - Country:US
Mailing Address - Phone:302-424-3100
Mailing Address - Fax:302-424-3800
Practice Address - Street 1:39 W CLARKE AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1839
Practice Address - Country:US
Practice Address - Phone:302-422-3100
Practice Address - Fax:302-424-3800
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10006872207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000023222Medicaid
DEH32345Medicare UPIN
DE1000023222Medicaid