Provider Demographics
NPI:1710962055
Name:SAM, DAVID ARTHUR (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ARTHUR
Last Name:SAM
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 1:111 BREWSTER ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4400
Mailing Address - Country:US
Mailing Address - Phone:401-729-3481
Mailing Address - Fax:401-729-3866
Practice Address - Street 1:1000 BROAD ST
Practice Address - Street 2:NOTRE DAME AMBULATORY CENTER
Practice Address - City:CENTRAL FALLS
Practice Address - State:RI
Practice Address - Zip Code:02863-1507
Practice Address - Country:US
Practice Address - Phone:401-726-1800
Practice Address - Fax:401-727-3556
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIMD10401207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0070570331OtherMEDICARE PTAN
RI7008639Medicaid
RI7008639Medicaid