Provider Demographics
NPI:1669497434
Name:TEKA, SAMSON TULU (MD)
Entity type:Individual
Prefix:DR
First Name:SAMSON
Middle Name:TULU
Last Name:TEKA
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 1:1249 15TH ST STE 2000
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3662
Mailing Address - Country:US
Mailing Address - Phone:304-691-1000
Mailing Address - Fax:304-691-1063
Practice Address - Street 1:1249 15TH ST STE 2000
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3662
Practice Address - Country:US
Practice Address - Phone:304-691-1000
Practice Address - Fax:304-691-1063
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4894128-1205207R00000X
WV23621207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
613154600OtherFECA
WV3810015554Medicaid
WV613154600OtherFEDERAL BLACK LUNG/FECA
WV4272272Medicare UPIN