Provider Demographics
NPI:1013443480
Name:SAMS, DERICA NICOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:DERICA
Middle Name:NICOLE
Last Name:SAMS
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 1:123 CHURMENT CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-6434
Mailing Address - Country:US
Mailing Address - Phone:706-340-4330
Mailing Address - Fax:
Practice Address - Street 1:PEDIATRIC EDUCATION OFFICE UNC AT CHAPEL HL
Practice Address - Street 2:CAMPUS BOX 7593
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7593
Practice Address - Country:US
Practice Address - Phone:919-966-3172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC227179208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics