Provider Demographics
NPI:1043287816
Name:GERMANWALA, SAMIR V (DO)
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:V
Last Name:GERMANWALA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 19036
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4085
Mailing Address - Country:US
Mailing Address - Phone:903-381-7263
Mailing Address - Fax:903-381-7269
Practice Address - Street 1:709 HOLLYBROOK DR
Practice Address - Street 2:SUITE 2301
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-2411
Practice Address - Country:US
Practice Address - Phone:903-757-4691
Practice Address - Fax:903-757-4875
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2021-11-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL7729207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH32347Medicare UPIN