Basic Information
| Provider Information | |||||||||
| NPI: | 1275821076 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARLI | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | BENJAMIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10350 N MCCARRAN BLVD # 1037 | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895036848 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1155 MILL ST | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7759827878 | ||||||||
| FaxNumber: | 7759824196 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2011 | ||||||||
| LastUpdateDate: | 02/23/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD171068 | OR | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD60464673 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 17869 | NV | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 17869 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 12779614 | 01 | CAQH | OTHER |