Provider Demographics
NPI:1750333605
Name:DAVID, WILLIAM SAMUAL (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:SAMUAL
Last Name:DAVID
Suffix:
Gender:M
Credentials:MD PHD
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Mailing Address - Street 1:3215 IRVING AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-3319
Mailing Address - Country:US
Mailing Address - Phone:612-873-2595
Mailing Address - Fax:612-904-4270
Practice Address - Street 1:165 CAMBRIDGE ST
Practice Address - Street 2:MGH EMG/NEUROMUSCULAR UNIT 8TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2783
Practice Address - Country:US
Practice Address - Phone:617-643-2085
Practice Address - Fax:617-726-2019
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2012-10-15
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Provider Licenses
StateLicense IDTaxonomies
MN355022084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN079200400Medicaid
130000311Medicare ID - Type Unspecified
A99888Medicare UPIN