Provider Demographics
NPI:1386660876
Name:NATH, SAMIR KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:KUMAR
Last Name:NATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4002 GARTH RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3180
Mailing Address - Country:US
Mailing Address - Phone:281-422-7970
Mailing Address - Fax:281-422-7960
Practice Address - Street 1:4002 GARTH RD
Practice Address - Street 2:SUITE 120
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3180
Practice Address - Country:US
Practice Address - Phone:281-422-7970
Practice Address - Fax:281-422-7960
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXL8858207RG0100X, 207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151784904Medicaid
TX8FX326OtherBLUE CROSS BLUE SHIELD
TX151784905Medicaid
TX8FT109OtherBLUE CROSS BLUE SHIELD
TX481234ZSWDMedicare PIN
TX481234YMVQMedicare PIN
TXH65369Medicare UPIN