Provider Demographics
NPI:1609066471
Name:DAVID E SAMUEL DPM
Entity Type:Organization
Organization Name:DAVID E SAMUEL DPM
Other - Org Name:FOOT &ANKLE SPEC OF DEL CO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:EMANUAEL
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:610-328-9122
Mailing Address - Street 1:196 WEST SPROUL ROAD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064
Mailing Address - Country:US
Mailing Address - Phone:610-328-9122
Mailing Address - Fax:610-328-6219
Practice Address - Street 1:196 WEST SPROUL ROAD
Practice Address - Street 2:SUITE 107
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064
Practice Address - Country:US
Practice Address - Phone:610-328-9122
Practice Address - Fax:610-328-6219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003536L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2317760000OtherPERSONAL CHOICE GROUP
PA53913OtherBRAVO HEALTH
PA036474OtherJEFFREY D.LEHRMANMEDICARE
PA207731OtherADVANTRA FREEDOM
PA30026957OtherKEYSTONE MERCY
PA2317760000OtherKEYSTONE HMO
PA1007605920006Medicaid
PA1643217OtherBLUE SHIELD GROUP
PA2317760000OtherAMERIHEALTH ADM GROUP
PA4973770001Medicare NSC
PA2317760000OtherKEYSTONE HMO
PAP00110977Medicare PIN
PA53913OtherBRAVO HEALTH
PA2317760000OtherAMERIHEALTH ADM GROUP
PA1007605920006Medicaid