Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | TRAINING | OH |
Y | 207YP0228X | Pediatric Otolaryngology | 35.092090 | OH |
NPI | 1609089374 |
---|---|
Provider Name | Dr. Samantha Anne |
First Address | Cleveland, OH 44195-2538 |
Second Address | Cleveland, OH 44106-1716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2007 |
Last Update Date | 07/10/2020 |