1609066471 NPI number — DAVID E SAMUEL DPM

Table of content: (NPI 1609066471)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609066471 NPI number — DAVID E SAMUEL DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID E SAMUEL DPM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1609066471
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
196 WEST SPROUL ROAD
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-328-9122
Provider Business Mailing Address Fax Number:
610-328-6219

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
196 WEST SPROUL ROAD
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-328-9122
Provider Business Practice Location Address Fax Number:
610-328-6219
Provider Enumeration Date:
07/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SAMUEL
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
EMANUAEL
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
610-328-9122

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  SC003536L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2317760000 . This is a "PERSONAL CHOICE GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 53913 . This is a "BRAVO HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 036474 . This is a "JEFFREY D.LEHRMANMEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 207731 . This is a "ADVANTRA FREEDOM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30026957 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2317760000 . This is a "KEYSTONE HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007605920006 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1643217 . This is a "BLUE SHIELD GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2317760000 . This is a "AMERIHEALTH ADM GROUP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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