Provider Demographics
NPI:1326142688
Name:SAMRAO, SATWANT S (MD)
Entity Type:Individual
Prefix:
First Name:SATWANT
Middle Name:S
Last Name:SAMRAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 E ALMOND AVE
Mailing Address - Street 2:STE 6
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-5600
Mailing Address - Country:US
Mailing Address - Phone:559-674-8838
Mailing Address - Fax:559-674-5848
Practice Address - Street 1:500 EAST ALMOND AVENUE
Practice Address - Street 2:SUITE 6
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637
Practice Address - Country:US
Practice Address - Phone:559-674-8838
Practice Address - Fax:559-674-5848
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA48143207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A481431Medicaid
CA00A481431Medicare PIN
CA00A481431Medicaid