MEDICARE: DR. PRIYA SAMANT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	18731	OK
2	208000000X	Pediatrics Physician	18731	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	18731	OTHER	OK	MEDICAL LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	14296	OTHER	OK	BNDD

General Provider Information

NPI Number	:	1114901204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRIYA SAMANT M.D.

Provider Business Mailing Address
First Line	:	411 NW 11TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73103-3913
Country	:	US
Telephone Number	:	405-272-0476
Fax Number	:	405-272-0730

Provider Business Practice Location Address
First Line	:	411 NW 11TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73103-3913
Country	:	US
Telephone Number	:	405-272-0476
Fax Number	:	405-272-0730

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	03/07/2023

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Directions to “ DR. PRIYA SAMANT M.D.” Practice Location

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