Provider Demographics
NPI:1093719502
Name:SAMAAN, WALID (MD)
Entity Type:Individual
Prefix:
First Name:WALID
Middle Name:
Last Name:SAMAAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2723 S 7TH STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-3558
Mailing Address - Country:US
Mailing Address - Phone:812-238-1730
Mailing Address - Fax:812-242-1565
Practice Address - Street 1:1040 SIERRA DR
Practice Address - Street 2:SUITE 400
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-7240
Practice Address - Country:US
Practice Address - Phone:317-528-4270
Practice Address - Fax:317-865-8336
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042568A207RC0200X
IN01042568207RP1001X
PAMD449780207RP1001X, 207RC0200X
OH35.060505207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100360050AMedicaid
IN000000991174OtherANTHEM PIN
IN147180LLLMedicare PIN
IN100360050AMedicaid
ININ2762012Medicare PIN