Healthcare Provider Details

I. General information

NPI: 1316470958
Provider Name (Legal Business Name): ALFRED THUNTY SAMURA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 S ORANGE AVE
SOUTH ORANGE NJ
07079-2698
US

IV. Provider business mailing address

506 KINGS DR
CHERRY HILL NJ
08003-3012
US

V. Phone/Fax

Practice location:
  • Phone: 932-761-1140
  • Fax:
Mailing address:
  • Phone: 267-237-1044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA10809100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR9681
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA10809100
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberDR-0026745
License Number StateDE
# 6
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number25MA10809100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: