Provider Demographics
NPI:1730136219
Name:SAMDANI, BESMA (MD)
Entity Type:Individual
Prefix:
First Name:BESMA
Middle Name:
Last Name:SAMDANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BESMA
Other - Middle Name:
Other - Last Name:HAQUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 525
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-0525
Mailing Address - Country:US
Mailing Address - Phone:610-933-8000
Mailing Address - Fax:610-917-1326
Practice Address - Street 1:826 MAIN ST
Practice Address - Street 2:SUITE100
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-4459
Practice Address - Country:US
Practice Address - Phone:610-933-8484
Practice Address - Fax:610-917-1326
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424617207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1011345200003Medicaid
PA1011345200003Medicaid