Provider Demographics
NPI:1083718712
Name:SAMSON, JANE (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:SAMSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-2323
Mailing Address - Country:US
Mailing Address - Phone:315-797-2314
Mailing Address - Fax:315-797-0850
Practice Address - Street 1:123 GENESEE ST
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-2323
Practice Address - Country:US
Practice Address - Phone:315-797-2314
Practice Address - Fax:315-797-0850
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221758207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY040426014483OtherFIDELIS MEDICAID
NY34571OtherRAILROAD MEDICARE
NY02200806Medicaid
NY085594OtherMVP
NY7234284OtherAETNA
NY10068900OtherCDPHP
NY2122373OtherUHC
H44831Medicare UPIN
NY2122373OtherUHC