Provider Demographics
NPI:1629135462
Name:SAMUEL, REENA (MD)
Entity Type:Individual
Prefix:DR
First Name:REENA
Middle Name:
Last Name:SAMUEL
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 1:1711 27TH ST
Mailing Address - Street 2:BRAUNLIN BLDG. STE 301
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2638
Mailing Address - Country:US
Mailing Address - Phone:740-354-5393
Mailing Address - Fax:740-353-9068
Practice Address - Street 1:1711 27TH ST
Practice Address - Street 2:BRAUNLIN BLDG. (K) STE 301
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2638
Practice Address - Country:US
Practice Address - Phone:740-354-5393
Practice Address - Fax:740-353-9068
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35074119207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2222919Medicaid
OHH060890Medicare PIN
OH2222919Medicaid
OH9312681Medicare PIN