Provider Demographics
NPI:1164861290
Name:SAMSONOV M.D. MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SAMSONOV M.D. MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:SAMSONOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-386-5388
Mailing Address - Street 1:PO BOX 16305
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-0305
Mailing Address - Country:US
Mailing Address - Phone:415-386-5388
Mailing Address - Fax:
Practice Address - Street 1:3542 MEADOWBROOK DR
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-5213
Practice Address - Country:US
Practice Address - Phone:415-386-5388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-21
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91227207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty