Provider Demographics
NPI:1578900106
Name:PRICE, SAMANTHA J (DPM)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:J
Last Name:PRICE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 NC HWY 105
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607
Mailing Address - Country:US
Mailing Address - Phone:828-386-1849
Mailing Address - Fax:828-386-1851
Practice Address - Street 1:2211 NC HWY 105
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607
Practice Address - Country:US
Practice Address - Phone:828-386-1849
Practice Address - Fax:828-386-1851
Is Sole Proprietor?:No
Enumeration Date:2013-05-22
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO60626134213E00000X
OH36.003748213E00000X
NC637213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0360207OtherLI
WA20650556Medicaid