Provider Demographics
NPI:1174564777
Name:SAMANICH, DAVID E (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:SAMANICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 CROCKER RD
Mailing Address - Street 2:SUITE 650
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-6966
Mailing Address - Country:US
Mailing Address - Phone:440-808-1905
Mailing Address - Fax:440-808-1907
Practice Address - Street 1:2001 CROCKER RD
Practice Address - Street 2:SUITE 650
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-6966
Practice Address - Country:US
Practice Address - Phone:440-808-1905
Practice Address - Fax:440-808-1907
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063283207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00749746OtherRAILROAD CARE
OH2063645Medicaid
OH7296951Medicare PIN
F28030Medicare UPIN
OHP00749746OtherRAILROAD CARE