Provider Demographics
NPI:1255304143
Name:SIMHA, SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:SIMHA
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:PO BOX 1798
Mailing Address - Street 2:DEPT 07-046
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38101-9715
Mailing Address - Country:US
Mailing Address - Phone:901-259-9200
Mailing Address - Fax:901-362-6618
Practice Address - Street 1:1028 CRESTHAVEN RD
Practice Address - Street 2:STE 101
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3895
Practice Address - Country:US
Practice Address - Phone:901-680-8146
Practice Address - Fax:901-680-8178
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN23948207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3077122Medicaid
TN3707403Medicare ID - Type Unspecified
TNF78788Medicare UPIN
TN3077122Medicaid