Provider Demographics
NPI:1568625127
Name:DEEL, SAMUEL PATTTON (DO)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:PATTTON
Last Name:DEEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 COEBURN AVE SW
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-2606
Mailing Address - Country:US
Mailing Address - Phone:276-679-0800
Mailing Address - Fax:276-679-0097
Practice Address - Street 1:338 COEBURN AVE SW
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-2606
Practice Address - Country:US
Practice Address - Phone:276-679-0800
Practice Address - Fax:276-679-0097
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR1660207R00000X
VA0102202849207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1568625127Medicaid
VAP00998574OtherRR MEDICARE
VAVV2129BMedicare PIN
VA1568625127Medicaid