Provider Demographics
NPI:1558482455
Name:SAMUELS, WILLIAM OSCAR (M D)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:OSCAR
Last Name:SAMUELS
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 HOPE ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-1631
Mailing Address - Country:US
Mailing Address - Phone:401-272-5550
Mailing Address - Fax:401-273-3343
Practice Address - Street 1:480 HOPE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-1631
Practice Address - Country:US
Practice Address - Phone:401-272-5550
Practice Address - Fax:401-273-3343
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI49102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1443-6OtherBLUE CROSS OF RI
RIC90251Medicare UPIN