Provider Demographics
NPI:1770553802
Name:ABU-SAMRAH, SAMEER ABDALLAH (MD)
Entity type:Individual
Prefix:
First Name:SAMEER
Middle Name:ABDALLAH
Last Name:ABU-SAMRAH
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:PO BOX 15645
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89114-5645
Mailing Address - Country:US
Mailing Address - Phone:702-560-2879
Mailing Address - Fax:702-560-2928
Practice Address - Street 1:2716 N TENAYA WAY
Practice Address - Street 2:#428
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0424
Practice Address - Country:US
Practice Address - Phone:702-242-7572
Practice Address - Fax:702-243-0589
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7131207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2019543Medicaid
NV01WCHKL33Medicare ID - Type Unspecified
NV2019543Medicaid