MEDICARE: SAM WAIRIRI 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	2085R0202X	Diagnostic Radiology Physician	MD60676520	WA
2	2085R0202X	Diagnostic Radiology Physician	21964	TN

General Provider Information

NPI Number	:	1871931667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAM WAIRIRI M.D

Provider Business Mailing Address
First Line	:	1458 GROVE MEADOW CT
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38138-3307
Country	:	US
Telephone Number	:	650-863-1135
Fax Number	:

Provider Business Practice Location Address
First Line	:	1458 GROVE MEADOW CT
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38138-3307
Country	:	US
Telephone Number	:	650-863-1135
Fax Number	:

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

Provider Enumeration Date	:	06/13/2013
Last Update Date	:	10/02/2025

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