Basic Information
| Provider Information | |||||||||
| NPI: | 1023071453 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EID | ||||||||
| FirstName: | SAMIA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9313 S MASON MONTGOMERY RD | ||||||||
| Address2: | STE. 250 | ||||||||
| City: | MASON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450408008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135846898 | ||||||||
| FaxNumber: | 5135846976 | ||||||||
| Practice Location | |||||||||
| Address1: | 9313 S MASON MONTGOMERY RD | ||||||||
| Address2: | STE. 250 | ||||||||
| City: | MASON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450408008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135846898 | ||||||||
| FaxNumber: | 5135846976 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2006 | ||||||||
| LastUpdateDate: | 03/20/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35050588E | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0615856 | 05 | OH | MEDICAID | 200114190 | 05 | IN | MEDICAID |