Provider Demographics
NPI:1144386962
Name:SAMPSON OBGYN PA
Entity Type:Organization
Organization Name:SAMPSON OBGYN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-592-1112
Mailing Address - Street 1:417 VANCE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-4001
Mailing Address - Country:US
Mailing Address - Phone:910-592-1112
Mailing Address - Fax:910-592-3539
Practice Address - Street 1:417 VANCE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-4001
Practice Address - Country:US
Practice Address - Phone:910-592-1112
Practice Address - Fax:910-592-3539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89016TCMedicaid
NC2344834Medicare ID - Type Unspecified