Provider Demographics
NPI:1659506624
Name:SAMUEL, BISHOY T (MD)
Entity Type:Individual
Prefix:DR
First Name:BISHOY
Middle Name:T
Last Name:SAMUEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8220 MEADOWBRIDGE RD STE 310
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-2340
Mailing Address - Country:US
Mailing Address - Phone:804-417-0120
Mailing Address - Fax:804-277-3029
Practice Address - Street 1:8220 MEADOWBRIDGE RD STE 310
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2340
Practice Address - Country:US
Practice Address - Phone:804-417-0120
Practice Address - Fax:804-277-3029
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL34453208D00000X
CAA148818208D00000X
MST-3860208D00000X
VA01012749432083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice