Individual
SAMANTHA RAO SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3521 NW SAMARITAN DR STE 201, CORVALLIS, OR 97330-4744
(541) 768-5140
Mailing address
PO BOX 1189, CORVALLIS, OR 97339-1189
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD173772
OR
207R00000X
Internal Medicine Physician
MD424815
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080097556
RAILROAD MEDICARE
PA
05
—
1015043540001
—
PA
05
—
500692604
—
OR
01
—
597586
MEDICARE GROUP
PA
Enumeration date
12/01/2005
Last updated
01/14/2021
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