Provider Demographics
NPI:1588698245
Name:CHOUBAH, SAMAR A (MD)
Entity type:Individual
Prefix:
First Name:SAMAR
Middle Name:A
Last Name:CHOUBAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1029
Mailing Address - Country:US
Mailing Address - Phone:508-941-7009
Mailing Address - Fax:
Practice Address - Street 1:650 CENTRE ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3308
Practice Address - Country:US
Practice Address - Phone:508-941-7766
Practice Address - Fax:508-584-5455
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA227452207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2120402Medicaid
MA2120402Medicaid