Provider Demographics
NPI:1073509170
Name:SAMBAT, PAULINO D JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PAULINO
Middle Name:D
Last Name:SAMBAT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 FALCON DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-1931
Mailing Address - Country:US
Mailing Address - Phone:540-898-8400
Mailing Address - Fax:540-898-6642
Practice Address - Street 1:106 FALCON DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-1931
Practice Address - Country:US
Practice Address - Phone:540-898-8400
Practice Address - Fax:540-898-6642
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101021882208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1034031OtherFIRST HEALTH
4385900OtherAETNA
540992335-01OtherSOUTHERN HEALTH
0478594OtherHMO
2551020OtherCIGNA
010201OtherBS
10785OtherSENTARA
17 00515OtherUNITED HEALTHCARE
213149OtherMDIPA
VA7341440Medicaid
540992335OtherTRICARE
17 00515OtherUNITED HEALTHCARE
2551020OtherCIGNA