Provider Demographics
NPI:1407383706
Name:NGU, SAM (MD)
Entity Type:Individual
Prefix:MR
First Name:SAM
Middle Name:
Last Name:NGU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SINGLETON RIDGE RD
Mailing Address - Street 2:ATTENTION PNS CREDENTIALING
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-9142
Mailing Address - Country:US
Mailing Address - Phone:843-234-6946
Mailing Address - Fax:
Practice Address - Street 1:394 SINGLETON RIDGE RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-9150
Practice Address - Country:US
Practice Address - Phone:843-347-8050
Practice Address - Fax:843-347-8049
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2023-07-17
Deactivation Date:2017-12-18
Deactivation Code:
Reactivation Date:2018-01-30
Provider Licenses
StateLicense IDTaxonomies
SC89106207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology