Provider Demographics
NPI:1376868950
Name:AMSDELL, SIMON LEVI (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:LEVI
Last Name:AMSDELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1487 STONE HILL RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-5401
Mailing Address - Country:US
Mailing Address - Phone:419-290-8102
Mailing Address - Fax:
Practice Address - Street 1:2 W CRESCENT PARK
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-2111
Practice Address - Country:US
Practice Address - Phone:814-406-0035
Practice Address - Fax:814-726-9412
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD457305207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery