Provider Demographics
NPI:1043212541
Name:SAMAHA, FOUAD J (MD)
Entity Type:Individual
Prefix:
First Name:FOUAD
Middle Name:J
Last Name:SAMAHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-0086
Mailing Address - Country:US
Mailing Address - Phone:781-749-9071
Mailing Address - Fax:781-749-2133
Practice Address - Street 1:2300 CROWN COLONY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0902
Practice Address - Country:US
Practice Address - Phone:617-786-7600
Practice Address - Fax:617-786-7616
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA78298208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3113175Medicaid
MAE62357Medicare UPIN
MA3113175Medicaid