Provider Demographics
NPI:1780654996
Name:AL-SAMKARI, OSAMA (MD)
Entity Type:Individual
Prefix:
First Name:OSAMA
Middle Name:
Last Name:AL-SAMKARI
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 1:1121 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45410-2810
Mailing Address - Country:US
Mailing Address - Phone:937-258-1467
Mailing Address - Fax:937-258-0236
Practice Address - Street 1:1121 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45410-2810
Practice Address - Country:US
Practice Address - Phone:937-258-1467
Practice Address - Fax:937-258-0236
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3540644207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0404735Medicaid
A78989Medicare UPIN
AL0467913Medicare ID - Type Unspecified