Provider Demographics
NPI:1811033764
Name:SAMUELS, ALLEN J (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:J
Last Name:SAMUELS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2861 W 26TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-3064
Mailing Address - Country:US
Mailing Address - Phone:814-835-8093
Mailing Address - Fax:814-835-8097
Practice Address - Street 1:2861 W 26TH ST STE 2
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-3064
Practice Address - Country:US
Practice Address - Phone:814-835-8093
Practice Address - Fax:814-835-8097
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034675E207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD187804YUNMMedicare UPIN
C33088Medicare UPIN
MD187804EBKMedicare PIN