Provider Demographics
NPI:1699507335
Name:SAMAMRA, RAED R
Entity type:Individual
Prefix:
First Name:RAED
Middle Name:R
Last Name:SAMAMRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 ARBORHILL LN
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-6246
Mailing Address - Country:US
Mailing Address - Phone:919-819-1672
Mailing Address - Fax:
Practice Address - Street 1:505 ARBORHILL LN
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-6246
Practice Address - Country:US
Practice Address - Phone:919-819-1672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver