Provider Demographics
NPI:1093004988
Name:GHAFFAR, SAMIA ABDUL (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMIA
Middle Name:ABDUL
Last Name:GHAFFAR
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 1:2625 E DIVISADERO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1431
Mailing Address - Country:US
Mailing Address - Phone:559-453-5200
Mailing Address - Fax:
Practice Address - Street 1:45 E RIVER PARK PL W STE 104
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-1565
Practice Address - Country:US
Practice Address - Phone:559-320-0530
Practice Address - Fax:559-320-0532
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA122660207XS0117X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8952740Medicare PIN
WA1093004988Medicaid