Provider Demographics
NPI:1467603365
Name:CHARABATY, SAMAR M (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMAR
Middle Name:M
Last Name:CHARABATY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7880 WREN AVE STE C131
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-7801
Mailing Address - Country:US
Mailing Address - Phone:408-848-2170
Mailing Address - Fax:408-848-4244
Practice Address - Street 1:7880 WREN AVE STE C131
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-7801
Practice Address - Country:US
Practice Address - Phone:408-848-2170
Practice Address - Fax:408-848-4244
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2021-06-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA104924207RR0500X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A1049420Medicaid
CA0A1049420Medicaid
CAZZZ02040ZOtherLAUREL MEDICARE GROUP PTAN