Provider Demographics
NPI:1689647059
Name:PURPURA, SAMUEL PAUL JR (DO)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:PAUL
Last Name:PURPURA
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:928 JAYMOR RD
Mailing Address - Street 2:STE A-100
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966
Mailing Address - Country:US
Mailing Address - Phone:215-322-5002
Mailing Address - Fax:215-322-5008
Practice Address - Street 1:928 JAYMOR RD
Practice Address - Street 2:STE A-100
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966
Practice Address - Country:US
Practice Address - Phone:215-322-5002
Practice Address - Fax:215-322-5008
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05009043L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
086875OtherMEDICARE GROUP NUMBER
086875OtherMEDICARE GROUP NUMBER
034025Medicare ID - Type UnspecifiedTNR MEDICARE PROVIDER NUM