Provider Demographics
NPI:1255968665
Name:AZAR, SAMAREH CUNNINGHAM (MD)
Entity type:Individual
Prefix:DR
First Name:SAMAREH
Middle Name:CUNNINGHAM
Last Name:AZAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SAMAREH
Other - Middle Name:STEPHANIE
Other - Last Name:DADASHAZAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:234 GOODMAN STREET, ML 0781
Mailing Address - Street 2:INTERNAL MEDICINE
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2364
Mailing Address - Country:US
Mailing Address - Phone:513-584-4505
Mailing Address - Fax:513-584-0468
Practice Address - Street 1:2440 E 5TH ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-3525
Practice Address - Country:US
Practice Address - Phone:903-595-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXU9203207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program