Provider Demographics
NPI:1689814386
Name:SAM, MAMMEN ASHISH (MD)
Entity Type:Individual
Prefix:DR
First Name:MAMMEN
Middle Name:ASHISH
Last Name:SAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:929 GESSNER
Mailing Address - Street 2:SUITE 2450
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2593
Mailing Address - Country:US
Mailing Address - Phone:713-464-9939
Mailing Address - Fax:
Practice Address - Street 1:2416 S 13TH ST APT 626
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-7815
Practice Address - Country:US
Practice Address - Phone:254-421-1598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT182731207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine