Provider Demographics
NPI:1376171728
Name:BOSAK, SAMANTHA ALLISON (DO)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ALLISON
Last Name:BOSAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 RIDGE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:NEWTON FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44444-1264
Mailing Address - Country:US
Mailing Address - Phone:330-872-0330
Mailing Address - Fax:
Practice Address - Street 1:340 RIDGE RD STE 1
Practice Address - Street 2:
Practice Address - City:NEWTON FALLS
Practice Address - State:OH
Practice Address - Zip Code:44444-1264
Practice Address - Country:US
Practice Address - Phone:330-872-0330
Practice Address - Fax:330-872-3033
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58.031511207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine