Provider Demographics
NPI:1902030455
Name:SAMADASHWILY, GEORGE MICHAEL (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MICHAEL
Last Name:SAMADASHWILY
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 NORTH 1900 EAST 4A330
Mailing Address - Street 2:UNIVERSITY OF UTAH, UNIVERSITY HOSPITAL, DERMATOLOGY
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132
Mailing Address - Country:US
Mailing Address - Phone:801-581-6465
Mailing Address - Fax:801-581-6484
Practice Address - Street 1:UNIVERSITY OF UTAH
Practice Address - Street 2:30 NORTH 1900 EAST 4A330
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-581-6465
Practice Address - Fax:801-581-6484
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program