Provider Demographics
NPI:1861654980
Name:CHUBINEH, SAMAN BAHRAM (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMAN
Middle Name:BAHRAM
Last Name:CHUBINEH
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 1:6044 WEXFORD MNR
Mailing Address - Street 2:
Mailing Address - City:CLARENCE CENTER
Mailing Address - State:NY
Mailing Address - Zip Code:14032-9435
Mailing Address - Country:US
Mailing Address - Phone:917-309-9030
Mailing Address - Fax:716-462-6000
Practice Address - Street 1:6631 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5934
Practice Address - Country:US
Practice Address - Phone:716-240-2296
Practice Address - Fax:716-462-6000
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2023-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251164-1207RG0100X
CT49359207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03140434Medicaid