Provider Demographics
NPI:1013357532
Name:ANDREAGGI, SAMANTHA RENEE (OD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:RENEE
Last Name:ANDREAGGI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SAMANTHA
Other - Middle Name:RENEE
Other - Last Name:HOUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:920 PROVIDENCE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-2976
Mailing Address - Country:US
Mailing Address - Phone:410-486-1010
Mailing Address - Fax:443-895-4822
Practice Address - Street 1:920 PROVIDENCE RD STE 100
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-2976
Practice Address - Country:US
Practice Address - Phone:443-394-8679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA 2355152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist