Provider Demographics
NPI:1013168673
Name:VERGANO, SAMANTHA ALEXANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:ALEXANDRA
Last Name:VERGANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1052 N SHORE RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-3155
Mailing Address - Country:US
Mailing Address - Phone:973-879-0576
Mailing Address - Fax:
Practice Address - Street 1:601 CHILDRENS LN
Practice Address - Street 2:DIVISION OF MEDICAL GENETICS AND METABOLISM
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1910
Practice Address - Country:US
Practice Address - Phone:757-668-9723
Practice Address - Fax:757-668-9724
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101251368207SG0201X
WA61507346208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)