Provider Demographics
NPI:1194467415
Name:SAM, RHEBA RACHEL (DO)
Entity type:Individual
Prefix:
First Name:RHEBA
Middle Name:RACHEL
Last Name:SAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 SUMMER ST FL 3
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-5519
Mailing Address - Country:US
Mailing Address - Phone:203-327-9321
Mailing Address - Fax:
Practice Address - Street 1:945 SUMMER ST FL 3
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5519
Practice Address - Country:US
Practice Address - Phone:203-327-9321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT81156207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine