Provider Demographics
NPI:1093791113
Name:MCCREEDY, SAMUEL JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:JAMES
Last Name:MCCREEDY
Suffix:
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 1:2 PROSPECT TER
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03581-1221
Mailing Address - Country:US
Mailing Address - Phone:603-874-4295
Mailing Address - Fax:603-932-7354
Practice Address - Street 1:2 PROSPECT TER
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:NH
Practice Address - Zip Code:03581-1221
Practice Address - Country:US
Practice Address - Phone:603-874-4295
Practice Address - Fax:603-932-7354
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 94347207Q00000X
GA056858207Q00000X
WAMD00045859207Q00000X
MEMD24218207Q00000X
MS17939207Q00000X
NH17973207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3106359Medicaid
MS02434814Medicaid