Provider Demographics
NPI:1164492021
Name:SAMUELS, VICTORIA R (MD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:R
Last Name:SAMUELS
Suffix:
Gender:F
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:PO BOX 751069
Mailing Address - Street 2:ECU PHYSICIANS
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:625 COUNTRY DAY RD
Practice Address - Street 2:GOLDSBORO NEUROLOGICAL SURGERY
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-8888
Practice Address - Country:US
Practice Address - Phone:252-731-4048
Practice Address - Fax:252-731-2402
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14997207T00000X
CT014997207T00000X
NC2014-00571208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC149976Medicaid
CT1164492021Medicaid
NC185WFOtherBCBS
NC1164492021Medicaid
NCNCH948AMedicare PIN
CTD400055056Medicare Oscar/Certification
SC149976Medicaid
SC5765Medicare ID - Type Unspecified