Provider Demographics
NPI:1942735659
Name:WERNER, SAMUEL (DO)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:WERNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 N MAIN ST STE 350
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-2500
Mailing Address - Country:US
Mailing Address - Phone:860-331-3016
Mailing Address - Fax:860-331-3019
Practice Address - Street 1:342 N MAIN ST STE 350
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-2500
Practice Address - Country:US
Practice Address - Phone:860-331-3016
Practice Address - Fax:860-331-3019
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT71101204D00000X, 207Q00000X
NJ25MB11231200204D00000X, 207Q00000X
PAOT017661207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM