Provider Demographics
NPI:1154318632
Name:CRITES-SAMS, DEBRA R (DO)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:R
Last Name:CRITES-SAMS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:DEBRA
Other - Middle Name:C
Other - Last Name:SAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 465
Mailing Address - Street 2:
Mailing Address - City:RONCEVERTE
Mailing Address - State:WV
Mailing Address - Zip Code:24970-0465
Mailing Address - Country:US
Mailing Address - Phone:304-645-4406
Mailing Address - Fax:304-645-4492
Practice Address - Street 1:1478 MAPLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:RONCEVERTE
Practice Address - State:WV
Practice Address - Zip Code:24970-8017
Practice Address - Country:US
Practice Address - Phone:304-645-4406
Practice Address - Fax:304-645-4492
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1139207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0041844000Medicaid
WV9317531Medicare ID - Type Unspecified
WV0041844000Medicaid