Provider Demographics
NPI:1598751067
Name:FLANNAGAN, SAMUEL W (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:W
Last Name:FLANNAGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 W 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-1069
Mailing Address - Country:US
Mailing Address - Phone:724-537-1870
Mailing Address - Fax:724-532-6975
Practice Address - Street 1:212 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1069
Practice Address - Country:US
Practice Address - Phone:724-537-1870
Practice Address - Fax:724-532-6975
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD010947E207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006682700010Medicaid
PA0006682700010Medicaid
PA103780WCCMedicare ID - Type Unspecified