Provider Demographics
NPI:1114038452
Name:BAROLD, SAMUEL SERGE (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:SERGE
Last Name:BAROLD
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 1:5806 MARINER'S WATCH DRIVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615
Mailing Address - Country:US
Mailing Address - Phone:813-891-1921
Mailing Address - Fax:813-891-1908
Practice Address - Street 1:4 COLUMBIA DRIVE
Practice Address - Street 2:CO-BENGT HERWEG MD HARBOURSIDE TOWER
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606
Practice Address - Country:US
Practice Address - Phone:813-259-0600
Practice Address - Fax:813-891-1908
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLORIDA ME 16747207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
B76479Medicare UPIN