Provider Demographics
NPI:1043414915
Name:GREGORY P SAMANO II DO PA
Entity Type:Organization
Organization Name:GREGORY P SAMANO II DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:P
Authorized Official - Last Name:SAMANO
Authorized Official - Suffix:II
Authorized Official - Credentials:DO
Authorized Official - Phone:407-543-3461
Mailing Address - Street 1:499 E CENTRAL PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-3449
Mailing Address - Country:US
Mailing Address - Phone:407-543-3461
Mailing Address - Fax:407-678-0627
Practice Address - Street 1:499 E CENTRAL PKWY STE 100
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-3449
Practice Address - Country:US
Practice Address - Phone:407-543-3461
Practice Address - Fax:407-678-0627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7764207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty