Provider Demographics
NPI:1184679573
Name:WESTRICK, SAMUEL JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:JOHN
Last Name:WESTRICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6080 FALLS RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209
Mailing Address - Country:US
Mailing Address - Phone:410-323-2757
Mailing Address - Fax:410-323-2715
Practice Address - Street 1:6080 FALLS RD
Practice Address - Street 2:SUITE 204
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209
Practice Address - Country:US
Practice Address - Phone:410-323-2757
Practice Address - Fax:410-323-2715
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0028625207Q00000X
MDD28625207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD335641800Medicaid
MD8535Medicare ID - Type Unspecified
MD335641800Medicaid