Provider Demographics
NPI:1346446622
Name:SAMPSON, TOMOKO RIE (MD)
Entity Type:Individual
Prefix:DR
First Name:TOMOKO
Middle Name:RIE
Last Name:SAMPSON
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 1:615 S NEW BALLAS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8221
Mailing Address - Country:US
Mailing Address - Phone:314-251-6339
Mailing Address - Fax:
Practice Address - Street 1:615 S NEW BALLAS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8221
Practice Address - Country:US
Practice Address - Phone:314-251-6339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT358062084N0400X
ORMD1661282084N0400X
CAA1422632084N0400X
AK1093732084N0400X
WAMD6015198152084N0400X
MO20220104022084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500671084Medicaid
MIM74460878Medicare UPIN
OR500671084Medicaid
ORR175224Medicare PIN
ORR175223Medicare PIN
ORR192446Medicare PIN
ORRF192445Medicare PIN