Provider Demographics
NPI:1710502539
Name:SAM MHANNA MD LLC
Entity Type:Organization
Organization Name:SAM MHANNA MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOUSSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MHANNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-964-7121
Mailing Address - Street 1:1111 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-2929
Mailing Address - Country:US
Mailing Address - Phone:440-964-7121
Mailing Address - Fax:
Practice Address - Street 1:1111 LAKE AVE
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-2929
Practice Address - Country:US
Practice Address - Phone:440-964-7121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty