Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | MD042597E | PA |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | MD042597E | PA |
NPI | 1255305017 |
---|---|
Provider Name | Fania Samuels |
First Address | Philadelphia, PA 19178-0001 |
Second Address | Philadelphia, PA 19116-3749 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2006 |
Last Update Date | 17/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001549406 | (05) | PA |
0015494060015 | (05) | PA |
0833050000 | KEYSTONE IBC (01) | PA |
30133381 | KEYSTONE FIRST (01) | PA |
806944 | HIGHMARK BLUE SHIELD (01) | PA |
8692853 | AETNA (01) | PA |