Provider Demographics
NPI:1518941327
Name:PENA, SAMARA (MD)
Entity Type:Individual
Prefix:
First Name:SAMARA
Middle Name:
Last Name:PENA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:736 CAMBRIDGE ST
Mailing Address - Street 2:CMP 5
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135
Mailing Address - Country:US
Mailing Address - Phone:617-789-2464
Mailing Address - Fax:617-562-7932
Practice Address - Street 1:11 NEVINS ST.
Practice Address - Street 2:SUITE 202
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135
Practice Address - Country:US
Practice Address - Phone:617-779-6700
Practice Address - Fax:617-779-6771
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA210451207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism