Provider Demographics
NPI:1245365790
Name:SAMUELSON, JOSHUA CLARK (DO)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:CLARK
Last Name:SAMUELSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6001 CHRISTIANA HOSPITAL
Mailing Address - Street 2:C/O ACADEMIC AFFAIRS, SUITE 2A00
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19718-0001
Mailing Address - Country:US
Mailing Address - Phone:302-477-3300
Mailing Address - Fax:302-477-3311
Practice Address - Street 1:1401 FOULK RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2763
Practice Address - Country:US
Practice Address - Phone:302-477-3300
Practice Address - Fax:302-477-3311
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC7-0003446207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine