1487216008 NPI number — SAMANTHA DUPLAK KINDELSPERGER OD

Table of content: SAMANTHA DUPLAK KINDELSPERGER OD (NPI 1487216008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487216008 NPI number — SAMANTHA DUPLAK KINDELSPERGER OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KINDELSPERGER
Provider First Name:
SAMANTHA
Provider Middle Name:
DUPLAK
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

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:
1487216008
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 ROSELAWN LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MALVERN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19355
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-941-2439
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3750 VIRGINIA BEACH BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23452-3411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-941-2439
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/03/2019

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: 152W00000X , with the licence number:  0618002800 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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