Healthcare Provider Details

I. General information

NPI: 1508863721
Provider Name (Legal Business Name): DR. SOUHEIL H SAMAHA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SOUHEIL SAMAHA M.D.

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 DR MARTIN LUTHER KING JR AVE NE
ALBUQUERQUE NM
87102-3619
US

IV. Provider business mailing address

230 E 52ND ST APT 2D
NEW YORK NY
10022-6208
US

V. Phone/Fax

Practice location:
  • Phone: 505-727-3170
  • Fax:
Mailing address:
  • Phone: 212-734-4484
  • Fax: 212-743-4486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number205745
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number205745
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number205745
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: