1598775801 NPI number — DR. TILLY EFFIE DUNCAN-SAMPSON MD

Table of content: DR. TILLY EFFIE DUNCAN-SAMPSON MD (NPI 1598775801)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598775801 NPI number — DR. TILLY EFFIE DUNCAN-SAMPSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUNCAN-SAMPSON
Provider First Name:
TILLY
Provider Middle Name:
EFFIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1598775801
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 BELLEFONTAINE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIMA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45804-2800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-998-4575
Provider Business Mailing Address Fax Number:
419-998-4586

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1005 BELLEFONTAINE AVE STE 245
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIMA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45804-2884
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-998-8230
Provider Business Practice Location Address Fax Number:
419-998-8231
Provider Enumeration Date:
08/09/2006

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: 208000000X , with the licence number:  35.077031 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com