Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | SC003536L | PA |
NPI | 1053491837 |
---|---|
Provider Name | David E Samuel |
First Address | Springfield, PA 19064-2045 |
Second Address | Springfield, PA 19064-2045 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 14/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00130001000004 | (05) | PA |
0549291000 | KEYSTONE HEALTH PLAN EAST (01) | PA |
1010163 | KEYSTONE MERCY (01) | PA |
1643217 | BLUE SHIELD GROUP NUMBER (01) | PA |
2317760000 | KEYSTONE HEALTH GROUP NUM (01) | PA |
3323 | ELDER HEALTH (01) | PA |
480021835 | PALMETTO/RR MEDICARE (01) | PA |
4973770001 | NHIC/DMERC (01) | PA |
712999 | BLUE SHIELD (01) | PA |
U28673 | (02) | PA |