Provider Demographics
NPI:1104044130
Name:ABEDIN, SAMI (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMI
Middle Name:
Last Name:ABEDIN
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 1:77 HOFFMAN AVE
Mailing Address - Street 2:APT. E
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-4558
Mailing Address - Country:US
Mailing Address - Phone:401-886-4830
Mailing Address - Fax:888-779-7670
Practice Address - Street 1:65 SOCKANOSSET CROSS RD
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-5536
Practice Address - Country:US
Practice Address - Phone:401-886-4830
Practice Address - Fax:888-779-7670
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD143822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RISA93953Medicaid
RI003413301Medicare PIN