Provider Demographics
NPI:1376506410
Name:NAMEY, SAMUEL ANTHONY (DO)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:ANTHONY
Last Name:NAMEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 DARROW RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-5021
Mailing Address - Country:US
Mailing Address - Phone:330-656-9304
Mailing Address - Fax:330-656-5901
Practice Address - Street 1:158 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:CONNEAUT
Practice Address - State:OH
Practice Address - Zip Code:44030
Practice Address - Country:US
Practice Address - Phone:440-593-1131
Practice Address - Fax:330-656-5901
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004038207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000269066OtherANTHEM
OH0778225Medicaid
OHN368734OtherWELLCARE
D77406Medicare UPIN
OHN368734OtherWELLCARE
OH930128060Medicare PIN