Provider Demographics
NPI: | 1710106422 |
---|---|
Name: | SAMA, ASHWIN REDDY (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | ASHWIN |
Middle Name: | REDDY |
Last Name: | SAMA |
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: | 925 CHESTNUT ST |
Mailing Address - Street 2: | SUITE 320A |
Mailing Address - City: | PHILADELPHIA |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 19107-4216 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 215-955-8874 |
Mailing Address - Fax: | 215-955-2340 |
Practice Address - Street 1: | 925 CHESTNUT ST |
Practice Address - Street 2: | SUITE 320A |
Practice Address - City: | PHILADELPHIA |
Practice Address - State: | PA |
Practice Address - Zip Code: | 19107-4216 |
Practice Address - Country: | US |
Practice Address - Phone: | 215-955-8874 |
Practice Address - Fax: | 215-955-2340 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-04-24 |
Last Update Date: | 2013-08-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NE | 5387 | 207R00000X |
PA | MT196387 | 207RH0003X |
PA | MD439419 | 207RX0202X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RX0202X | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | |
No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |