Provider Demographics
NPI:1346388568
Name:ORUSA, SAMSON KANLA (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMSON
Middle Name:KANLA
Last Name:ORUSA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:261 STONECROSSING DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-8404
Mailing Address - Country:US
Mailing Address - Phone:931-906-4366
Mailing Address - Fax:931-906-4365
Practice Address - Street 1:261 STONECROSSING DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-8404
Practice Address - Country:US
Practice Address - Phone:931-906-4366
Practice Address - Fax:931-906-4365
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN28275207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNG42668Medicare UPIN