Provider Demographics
NPI:1447303417
Name:SAMUEL, RAMEZ WADIE (MD)
Entity type:Individual
Prefix:DR
First Name:RAMEZ
Middle Name:WADIE
Last Name:SAMUEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAMEZ
Other - Middle Name:
Other - Last Name:SAMUEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:346 ROSEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07107-1722
Mailing Address - Country:US
Mailing Address - Phone:862-209-0242
Mailing Address - Fax:973-482-0274
Practice Address - Street 1:346 ROSEVILLE AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07107-1722
Practice Address - Country:US
Practice Address - Phone:862-209-0242
Practice Address - Fax:973-482-0274
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA72716207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine