Provider Demographics
NPI:1083243752
Name:SAMSON, RUTH TADESSE (MD)
Entity type:Individual
Prefix:DR
First Name:RUTH
Middle Name:TADESSE
Last Name:SAMSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 WATERS PL PH 7
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2731
Mailing Address - Country:US
Mailing Address - Phone:844-273-2786
Mailing Address - Fax:
Practice Address - Street 1:1250 WATERS PL PH 7
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2731
Practice Address - Country:US
Practice Address - Phone:844-273-2786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-05
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA390200000X
NY337251-01208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program