Individual
DR. OM SAMANTRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1906 BELLEVIEW AVE SE, ROANOKE, VA 24014-1838
(540) 981-7000
(540) 853-0931
Mailing address
213 S JEFFERSON ST STE 1006, ROANOKE, VA 24011-1713
(540) 224-5715
(540) 224-5684
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0101-253649
VA
207R00000X
Internal Medicine Physician
Primary
0101253649
VA
208M00000X
Hospitalist Physician
0101253649
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1477877439
—
VA
Enumeration date
03/19/2010
Last updated
02/12/2025
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