MEDICARE: JOHAN SAMANTA, MD PC

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	261Q00000X	Clinic/Center	25284	AZ

General Provider Information

NPI Number	:	1871782466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHAN SAMANTA, MD PC

Provider Business Mailing Address
First Line	:	7500 N DREAMY DRAW DR
Second Line	:	SUITE 133
City	:	PHOENIX
State	:	AZ
Zip	:	85020-4668
Country	:	US
Telephone Number	:	602-277-2228
Fax Number	:	602-265-9494

Provider Business Practice Location Address
First Line	:	7500 N DREAMY DRAW DR
Second Line	:	SUITE 133
City	:	PHOENIX
State	:	AZ
Zip	:	85020-4668
Country	:	US
Telephone Number	:	602-277-2228
Fax Number	:	602-265-9494

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHAN E SAMANTA
Credential	:	M.D.
Telephone Number	:	602-277-2228

Provider Enumeration Date	:	10/18/2007
Last Update Date	:	01/18/2017

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