Provider Demographics
NPI:1245219617
Name:SAMALA, RENATO RAMON VERAYO (MD)
Entity Type:Individual
Prefix:
First Name:RENATO
Middle Name:RAMON VERAYO
Last Name:SAMALA
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 1:9500 EUCLID AVE
Mailing Address - Street 2:R35
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-636-2598
Mailing Address - Fax:216-444-9464
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:R35
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-636-2598
Practice Address - Fax:216-444-9464
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.098856207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A897170Medicaid
CA00A897170Medicare ID - Type Unspecified
CA00A897170Medicaid