Provider Demographics
NPI:1275989410
Name:SAMAHA, PAMELA GEORGES
Entity Type:Individual
Prefix:MISS
First Name:PAMELA
Middle Name:GEORGES
Last Name:SAMAHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WEST 263 FARMINGTON AVENUE
Mailing Address - Street 2:INTERNAL MEDICINE ASSOCIATES, OUTPATIENT PAVILION
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032
Mailing Address - Country:US
Mailing Address - Phone:860-679-4477
Mailing Address - Fax:860-679-1025
Practice Address - Street 1:2 WEST 263 FARMINGTON AVENUE
Practice Address - Street 2:INTERNAL MEDICINE ASSOCIATES, OUTPATIENT PAVILION
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032
Practice Address - Country:US
Practice Address - Phone:860-679-4477
Practice Address - Fax:860-679-1025
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CT64804207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program