Provider Demographics
NPI:1396918280
Name:AL-SAMARRAI, TEEB (MD)
Entity type:Individual
Prefix:DR
First Name:TEEB
Middle Name:
Last Name:AL-SAMARRAI
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 1:850 MARINA BAY PKWY
Mailing Address - Street 2:BLDG P, FLR 2
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-6403
Mailing Address - Country:US
Mailing Address - Phone:510-620-3189
Mailing Address - Fax:
Practice Address - Street 1:850 MARINA BAY PKWY
Practice Address - Street 2:BLDG P, FLR 2
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-6403
Practice Address - Country:US
Practice Address - Phone:510-620-3189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA062647207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program