Provider Demographics
NPI:1710114780
Name:KARAKOSSIAN, SAMIRA (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMIRA
Middle Name:
Last Name:KARAKOSSIAN
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:PO BOX 612
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32170-0612
Mailing Address - Country:US
Mailing Address - Phone:386-382-7177
Mailing Address - Fax:
Practice Address - Street 1:3801 WOODBRIAR TRL
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-9627
Practice Address - Country:US
Practice Address - Phone:386-382-7177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111215207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00661300Medicaid