Provider Demographics
NPI:1598026148
Name:SAMRA, FARES (MD)
Entity Type:Individual
Prefix:
First Name:FARES
Middle Name:
Last Name:SAMRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:733 N BEERS ST STE U1
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1513
Mailing Address - Country:US
Mailing Address - Phone:732-739-2100
Mailing Address - Fax:732-739-0815
Practice Address - Street 1:733 N BEERS ST STE U1
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1513
Practice Address - Country:US
Practice Address - Phone:732-739-2100
Practice Address - Fax:732-739-0815
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA10597500208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery