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1134245913

NPI Code Detail

MEDICARE: SAMAN GHAFFARI D.O.

MEDICARE: SAMAN GHAFFARI D.O.

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	208100000X	Physical Medicine & Rehabilitation Physician	056446	GA
2	208100000X	Physical Medicine & Rehabilitation Physician	34.013816	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	511G700757	OTHER	GA	MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134245913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMAN GHAFFARI D.O.

Provider Business Mailing Address
First Line	:	1776 WOODSTEAD CT STE 208
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77380-1480
Country	:	US
Telephone Number	:	877-749-7428
Fax Number	:	512-628-3314

Provider Business Practice Location Address
First Line	:	33355 HEALTH CAMPUS BLVD
Second Line	:
City	:	AVON
State	:	OH
Zip	:	44011-1399
Country	:	US
Telephone Number	:	877-749-7428
Fax Number	:	512-628-3314

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	02/06/2020

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Directions to “ SAMAN GHAFFARI D.O.” Practice Location

Language	Start Address	Practice Location

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