Provider Demographics
NPI:1821066291
Name:SAMEL, ANDREW DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:DAVID
Last Name:SAMEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 EMORY ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-2434
Mailing Address - Country:US
Mailing Address - Phone:508-226-0400
Mailing Address - Fax:508-226-3301
Practice Address - Street 1:152 EMORY ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-2434
Practice Address - Country:US
Practice Address - Phone:508-226-0400
Practice Address - Fax:508-226-3301
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76041207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3095207Medicaid
MA076041OtherTUFTS
MAJ12610Medicare ID - Type Unspecified
MAE62379Medicare UPIN