Provider Demographics
NPI:1255389029
Name:SAMADI, RAMIN R (MD)
Entity type:Individual
Prefix:DR
First Name:RAMIN
Middle Name:R
Last Name:SAMADI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6654 SAINT ANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4579
Mailing Address - Country:US
Mailing Address - Phone:817-361-5907
Mailing Address - Fax:817-361-5909
Practice Address - Street 1:5900 OVERTON RIDGE BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3685
Practice Address - Country:US
Practice Address - Phone:817-423-1477
Practice Address - Fax:817-423-1481
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1447207P00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5671290001OtherDME
8C0574Medicare ID - Type Unspecified
TXE15434Medicare UPIN