Provider Demographics
NPI:1861486169
Name:SAMUEL, LEWIS R (MD)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:R
Last Name:SAMUEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:SOUTH JERSEY RADIOLOGY ASSOCIATES, PA
Mailing Address - Street 2:PO BOX 23355
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07189-0001
Mailing Address - Country:US
Mailing Address - Phone:856-770-0300
Mailing Address - Fax:856-770-0395
Practice Address - Street 1:100 CARNIE BLVD
Practice Address - Street 2:SUITE B-5 SOUTH JERSEY RADIOLOGY ASSOCIATES
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4512
Practice Address - Country:US
Practice Address - Phone:856-751-0123
Practice Address - Fax:856-751-0535
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA045804002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0814136OtherAETNA
NJ2420104Medicaid
A3738029OtherOXFORD HEALTH
0536797000OtherAMERIHEALTH
1089280OtherHORIZON NJ HEALTH
SA701402OtherHIGHMARK PA BLUE SHIELD
1241866OtherUNITED HEALTHCARE
NJD19350Medicare UPIN
0536797000OtherAMERIHEALTH