Provider Demographics
NPI:1891767208
Name:SAMAHA, TONY M (MD)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:M
Last Name:SAMAHA
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 1:5 NEPONSET ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-556-5400
Mailing Address - Fax:508-556-5401
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:SUITE 385
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608
Practice Address - Country:US
Practice Address - Phone:508-368-3168
Practice Address - Fax:508-368-3166
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19712207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2117932Medicaid
OH2147313Medicaid
WV5600242000Medicaid
G61058Medicare UPIN
MAA40400Medicare PIN
MA2117932Medicaid