Provider Demographics
NPI:1003618059
Name:SAMAL, MANASI (DO)
Entity type:Individual
Prefix:
First Name:MANASI
Middle Name:
Last Name:SAMAL
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7230 WINDSOR LN
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-1045
Mailing Address - Country:US
Mailing Address - Phone:301-466-2403
Mailing Address - Fax:301-466-2403
Practice Address - Street 1:1 WATERFRONT PL
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-5978
Practice Address - Country:US
Practice Address - Phone:301-293-6829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV390200000X207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology