Provider Demographics
NPI:1972130912
Name:MALDONADO, SAMUEL DAVID JR (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:DAVID
Last Name:MALDONADO
Suffix:JR
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1215 LEE ST BOX 800744
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22908-0816
Mailing Address - Country:US
Mailing Address - Phone:434-924-1931
Mailing Address - Fax:434-243-5770
Practice Address - Street 1:55 FRUIT STREET, BUL-1-130
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-3906
Practice Address - Fax:617-643-4237
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program