Provider Demographics
NPI:1740480193
Name:AL SAMARA, RASHA (MD)
Entity type:Individual
Prefix:
First Name:RASHA
Middle Name:
Last Name:AL SAMARA
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 1:2217 GRACEHAVEN WAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-4940
Mailing Address - Country:US
Mailing Address - Phone:770-586-0310
Mailing Address - Fax:770-586-0312
Practice Address - Street 1:738 OLD NORCROSS RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4462
Practice Address - Country:US
Practice Address - Phone:470-415-8320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA063592207R00000X, 207R00000X
MI4301089449207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5315030251OtherCONTROLLED SUBSTANCE