Provider Demographics
NPI:1558629204
Name:SAMPSON, COURTNEY AR (DO)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:AR
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:A
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:232 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16544-0002
Mailing Address - Country:US
Mailing Address - Phone:814-452-5216
Mailing Address - Fax:814-452-7005
Practice Address - Street 1:232 W 25TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16544-0002
Practice Address - Country:US
Practice Address - Phone:814-452-5216
Practice Address - Fax:814-452-7005
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY272635207Q00000X
PAOS017651207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program