Provider Demographics
NPI:1437432028
Name:WALSH, SAMANTHA J (PA-C)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:J
Last Name:WALSH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SAMANATHA
Other - Middle Name:J
Other - Last Name:HERRMANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:100 KNOWLSON AVE
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-1634
Mailing Address - Country:US
Mailing Address - Phone:724-891-2100
Mailing Address - Fax:724-891-2734
Practice Address - Street 1:100 KNOWLSON AVE
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-1634
Practice Address - Country:US
Practice Address - Phone:724-891-2100
Practice Address - Fax:724-891-2734
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATMA052591363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical