Provider Demographics
NPI:1013906627
Name:SAMUEL, LYNN H (MD)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:H
Last Name:SAMUEL
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 1:1560 CHAPMAN RD
Mailing Address - Street 2:
Mailing Address - City:STANARDSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22973-3620
Mailing Address - Country:US
Mailing Address - Phone:540-316-5604
Mailing Address - Fax:540-316-5601
Practice Address - Street 1:493 BLACKWELL RD
Practice Address - Street 2:SUITE 101A
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2628
Practice Address - Country:US
Practice Address - Phone:540-316-5604
Practice Address - Fax:540-316-5601
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044708207ZB0001X, 207ZC0500X, 207ZH0000X, 207ZP0102X, 207ZP0104X, 207ZP0105X, 207ZP0213X, 207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
No207ZP0104XAllopathic & Osteopathic PhysiciansPathologyChemical Pathology
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
No207ZP0213XAllopathic & Osteopathic PhysiciansPathologyPediatric Pathology
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6600590Medicaid
VAP00757523OtherRR MEDICARE
VAP00757523OtherRR MEDICARE
220000389Medicare ID - Type Unspecified
VA6600590Medicaid