Basic Information
| Provider Information | |||||||||
| NPI: | 1457703720 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REYES DASSUM | ||||||||
| FirstName: | SAMIRA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 81 HIGHLAND AVE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019702714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9787411200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 50 MAUDE ST | ||||||||
| Address2: | |||||||||
| City: | PROVIDENCE | ||||||||
| State: | RI | ||||||||
| PostalCode: | 029084325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014562437 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2016 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 267248 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | MD18356 | RI | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.