Provider Demographics
NPI:1922204601
Name:SAMSON, JOSE (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:SAMSON
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 1:1799 JOCKEYS WAY
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-3972
Mailing Address - Country:US
Mailing Address - Phone:215-497-0728
Mailing Address - Fax:
Practice Address - Street 1:1799 JOCKEYS WAY
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-3972
Practice Address - Country:US
Practice Address - Phone:215-497-0728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038428L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30060118OtherKEYSTONE MERCY
PA000953390 0005Medicaid
PA0022565000OtherIBX
PA30060272OtherKEYSTONE MERCY-LOWER BUCKS GROUP
PA413532OtherHIGHMARK BLUE SHIELD
PAP00718793OtherRAILROAD MEDICARE
PAP00774660OtherRR MEDICARE - BUCKS
PA000953390 0005Medicaid
PA413532ZDKTMedicare PIN