=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801166335
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MILFORD PULMONARY AND SLEEP CONSULTANTS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2011
-----------------------------------------------------
Last Update Date | 12/30/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 39 W CLARKE AVE
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19963-1839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-424-3100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39 W CLARKE AVE
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19963-1839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-424-3100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAN/OWNER
-----------------------------------------------------
Name | DR. MICHEL RAMEZ SAMAHA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 302-424-3100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RP1001X
-----------------------------------------------------
Taxonomy Name | Pulmonary Disease Physician
-----------------------------------------------------
License Number | C10006872
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------