Provider Demographics
NPI:1093874190
Name:SAMANT, VIJAY NARAYAN (MD PA)
Entity Type:Individual
Prefix:
First Name:VIJAY
Middle Name:NARAYAN
Last Name:SAMANT
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 273444
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33427-3444
Mailing Address - Country:US
Mailing Address - Phone:561-395-0737
Mailing Address - Fax:561-395-0766
Practice Address - Street 1:800 SW 15TH STREET
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486
Practice Address - Country:US
Practice Address - Phone:561-395-0737
Practice Address - Fax:561-395-0766
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0043269207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL06882910Medicaid
D63845Medicare UPIN
FL06882910Medicaid