Provider Demographics
NPI:1447224118
Name:BANG, SAM S (DO)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:S
Last Name:BANG
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1 HOSPITAL DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9350
Mailing Address - Country:US
Mailing Address - Phone:570-522-4110
Mailing Address - Fax:570-768-3911
Practice Address - Street 1:112 IRONSTONE DR
Practice Address - Street 2:
Practice Address - City:NORTHUMBERLAND
Practice Address - State:PA
Practice Address - Zip Code:17857-8543
Practice Address - Country:US
Practice Address - Phone:570-473-0545
Practice Address - Fax:570-473-7410
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2016-02-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS011866207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H56863Medicare UPIN
PA055396Medicare PIN