1053445130 NPI number — DR. BARBARA NAN SAMUELS M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053445130 NPI number — DR. BARBARA NAN SAMUELS M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SAMUELS

Provider First Name:

BARBARA

Provider Middle Name:

NAN

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

F

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:

1053445130

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/20/2021

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

275 MAMMOTH RD STE 1

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

MANCHESTER

Provider Business Mailing Address State Name:

NH

Provider Business Mailing Address Postal Code:

03109-4133

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

603-663-8285

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

275 MAMMOTH RD STE 1

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

MANCHESTER

Provider Business Practice Location Address State Name:

NH

Provider Business Practice Location Address Postal Code:

03109-4133

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

36-663-8285

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

03/14/2007

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2080P0006X , with the licence number:  222757-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2080P0006X , with the licence number: 27514 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2080P0006X , with the licence number: MD-13092 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2080P0006X , with the licence number: 18197 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 077ZN1 . This is a "EMPIRE BC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 143321 . This is a "GHI/HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 9161394 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 03159886 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: 9042528 . This is a "MVP HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 5908117 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
• Identifier: 100127000093 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 147AA . This is a "BCBS NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: PRC200203901 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".