Provider Demographics
NPI:1639113624
Name:SAMAHA, ANTOINE L (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTOINE
Middle Name:L
Last Name:SAMAHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3219 CLIFTON AVE
Mailing Address - Street 2:STE 325
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220
Mailing Address - Country:US
Mailing Address - Phone:513-861-0800
Mailing Address - Fax:513-861-5111
Practice Address - Street 1:3219 CLIFTON AVE
Practice Address - Street 2:STE 325
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220
Practice Address - Country:US
Practice Address - Phone:513-861-0800
Practice Address - Fax:513-861-5111
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35077206207RN0300X
KY33828207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2216702Medicaid
KY64713100Medicaid
IN2000454720Medicaid
OH390007233OtherMEDICARE RAILROAD
KY0514419Medicare PIN
OH390007233OtherMEDICARE RAILROAD
OHG97063Medicare UPIN