Provider Demographics
NPI:1396768412
Name:MAPLETHORPE, SAMANTHA MARIE (MD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:MARIE
Last Name:MAPLETHORPE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2623 W PUMPKIN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-3027
Mailing Address - Country:US
Mailing Address - Phone:623-232-0082
Mailing Address - Fax:623-440-0501
Practice Address - Street 1:390 E SUNSET WAY
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-3441
Practice Address - Country:US
Practice Address - Phone:425-369-1342
Practice Address - Fax:425-395-0245
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ53948207Q00000X
WAMD00041639207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAI02432Medicare UPIN