Provider Demographics
NPI:1700215431
Name:KEITER, SAMANTHA L (PAC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:L
Last Name:KEITER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:L
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:110 HOSPITAL ROAD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-4041
Mailing Address - Country:US
Mailing Address - Phone:410-535-2005
Mailing Address - Fax:410-535-5761
Practice Address - Street 1:110 HOSPITAL RD
Practice Address - Street 2:SUITE 310
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4019
Practice Address - Country:US
Practice Address - Phone:410-535-2005
Practice Address - Fax:410-535-5761
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC05217363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical