Provider Demographics
NPI:1649420175
Name:SAMUEL, EMILIA CAMPBELL (MD)
Entity Type:Individual
Prefix:
First Name:EMILIA
Middle Name:CAMPBELL
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EMILIA
Other - Middle Name:LOUISE PICARD
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2221 NE 139TH STREET
Mailing Address - Street 2:LEGACY SALMON CREEK
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686
Mailing Address - Country:US
Mailing Address - Phone:410-955-3416
Mailing Address - Fax:
Practice Address - Street 1:2221 NE 139TH STREET
Practice Address - Street 2:LEGACY SALMON CREEK
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686
Practice Address - Country:US
Practice Address - Phone:800-213-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-20
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD173221207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2048424Medicaid