Provider Demographics
NPI:1780188615
Name:SAM, ASHLEY ELIZABETH (DO)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:ELIZABETH
Last Name:SAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOSTON CHILDREN'S HOSPITAL
Mailing Address - Street 2:300 LONGWOOD AVE # BADER634
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:609-230-0845
Mailing Address - Fax:
Practice Address - Street 1:BOSTON CHILDREN'S HOSPITAL
Practice Address - Street 2:300 LONGWOOD AVE # BADER634
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:609-230-0845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102205853208000000X
MA286763208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics