Provider Demographics
NPI:1164482071
Name:SAMSON, MICHAEL JOHN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
Last Name:SAMSON
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 1:44 ELM ST
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086
Mailing Address - Country:US
Mailing Address - Phone:207-725-4455
Mailing Address - Fax:207-725-4861
Practice Address - Street 1:44 ELM ST
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086
Practice Address - Country:US
Practice Address - Phone:207-725-4455
Practice Address - Fax:207-725-4861
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME015351207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME178190000Medicaid
A66383Medicare UPIN
000958501Medicare PIN