1902030455 NPI number — DR. GEORGE MICHAEL SAMADASHWILY M.D PH.D

Table of content: DR. GEORGE MICHAEL SAMADASHWILY M.D PH.D (NPI 1902030455)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902030455 NPI number — DR. GEORGE MICHAEL SAMADASHWILY M.D PH.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAMADASHWILY
Provider First Name:
GEORGE
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D PH.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902030455
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 NORTH 1900 EAST 4A330
Provider Second Line Business Mailing Address:
UNIVERSITY OF UTAH, UNIVERSITY HOSPITAL, DERMATOLOGY
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-581-6465
Provider Business Mailing Address Fax Number:
801-581-6484

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UNIVERSITY OF UTAH
Provider Second Line Business Practice Location Address:
30 NORTH 1900 EAST 4A330
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84132-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-581-6465
Provider Business Practice Location Address Fax Number:
801-581-6484
Provider Enumeration Date:
05/13/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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