Provider Demographics
NPI:1417910951
Name:AHMAD, SAMARINA (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMARINA
Middle Name:
Last Name:AHMAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11511 SHADOW CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7298
Mailing Address - Country:US
Mailing Address - Phone:713-442-0000
Mailing Address - Fax:
Practice Address - Street 1:3917 WEST RD
Practice Address - Street 2:SUITE A
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-2275
Practice Address - Country:US
Practice Address - Phone:505-661-8900
Practice Address - Fax:505-661-8916
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063198207R00000X, 208M00000X
TXU4730207R00000X, 207RG0300X
NMMD2010-0715207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408866200Medicaid
NMNM303371OtherMEDICARE PTAN
MDCA8374OtherR/R MEDICARE GROUP #
MDP00314793OtherR/R MEDICARE PROVIDER #
NMMD2010-0715OtherNM STATE LICENSE
MDS589M969Medicare PIN
MD408866200Medicaid
MDI46614Medicare UPIN
MD157834ZD2XMedicare PIN