Provider Demographics
NPI:1407297971
Name:LYMAN, SAMANTHA LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LEE
Last Name:LYMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 STAFFORD ST STE 154
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-3583
Mailing Address - Country:US
Mailing Address - Phone:413-748-7095
Mailing Address - Fax:413-733-5604
Practice Address - Street 1:300 STAFFORD ST STE 154
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3583
Practice Address - Country:US
Practice Address - Phone:413-748-7095
Practice Address - Fax:413-733-5604
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002938363AM0700X, 363AS0400X
MAPA6554363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003029386Medicaid