Provider Demographics
NPI:1750803888
Name:SAMERAH RAZUMAN MD PLLC
Entity type:Organization
Organization Name:SAMERAH RAZUMAN MD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SAMERAH
Authorized Official - Middle Name:
Authorized Official - Last Name:RAZUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-465-1170
Mailing Address - Street 1:2000 HARTMAN RD STE 1
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-4412
Mailing Address - Country:US
Mailing Address - Phone:772-465-1170
Mailing Address - Fax:
Practice Address - Street 1:2000 HARTMAN RD STE 1
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-4412
Practice Address - Country:US
Practice Address - Phone:772-465-1170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL82363207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261799400Medicaid