Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 03945 | MD |
NPI | 1003381377 |
---|---|
Provider Name | Dr. Andrea Lynnette Samuels |
First Address | Baltimore, MD 21229-1240 |
Second Address | Baltimore, MD 21229-2126 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2018 |
Last Update Date | 12/10/2018 |