Provider Demographics
NPI:1174815427
Name:SAMS, TATIANA VLADIMIROVNA (MD)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:VLADIMIROVNA
Last Name:SAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TATIANA
Other - Middle Name:
Other - Last Name:IANKOVITCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5800 HOLLIS ST FL 4
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2016
Mailing Address - Country:US
Mailing Address - Phone:510-901-3552
Mailing Address - Fax:
Practice Address - Street 1:5800 HOLLIS ST FL 4
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-2016
Practice Address - Country:US
Practice Address - Phone:510-901-3552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA130098207R00000X, 207RE0101X
SC85122207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine