Provider Demographics
NPI:1164492831
Name:SAMUEL, DHINESH J (MD)
Entity Type:Individual
Prefix:MR
First Name:DHINESH
Middle Name:J
Last Name:SAMUEL
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 1:131 E CUNNINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001
Mailing Address - Country:US
Mailing Address - Phone:724-283-0212
Mailing Address - Fax:724-283-2404
Practice Address - Street 1:131 E CUNNINGHAM ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001
Practice Address - Country:US
Practice Address - Phone:724-283-0212
Practice Address - Fax:724-283-2404
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD419646207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01956645Medicaid
H83456Medicare UPIN
PA069539Q3FMedicare ID - Type Unspecified