Provider Demographics
NPI:1942546148
Name:FREDERICK K. SAMSEL, M.D., P.A.
Entity Type:Organization
Organization Name:FREDERICK K. SAMSEL, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:STRADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-422-4666
Mailing Address - Street 1:100 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1812
Mailing Address - Country:US
Mailing Address - Phone:302-422-4666
Mailing Address - Fax:302-422-6064
Practice Address - Street 1:100 KINGS HWY
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1812
Practice Address - Country:US
Practice Address - Phone:302-422-4666
Practice Address - Fax:302-422-6064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-17
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10002610207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE159779OtherMEDICARE
DE0000175502Medicaid
DE0000020401Medicaid
DE276473OtherGROUP PTAN
DE08D0206762OtherCLIA WAIVER
DE0000175502Medicaid