Provider Demographics
NPI:1841878055
Name:BESHAH, SAMRIE (MD)
Entity type:Individual
Prefix:
First Name:SAMRIE
Middle Name:
Last Name:BESHAH
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 1:3959 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-1559
Mailing Address - Country:US
Mailing Address - Phone:212-305-8504
Mailing Address - Fax:
Practice Address - Street 1:1880 LIVINGSTON AVE STE 102
Practice Address - Street 2:
Practice Address - City:WEST ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-3426
Practice Address - Country:US
Practice Address - Phone:651-552-7999
Practice Address - Fax:651-552-0777
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN77308208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics