Provider Demographics
NPI:1396929469
Name:BAROODY, SAMUEL C (DO)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:C
Last Name:BAROODY
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 1:824 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:AVALON
Mailing Address - State:PA
Mailing Address - Zip Code:15202-2706
Mailing Address - Country:US
Mailing Address - Phone:412-766-3232
Mailing Address - Fax:412-766-4320
Practice Address - Street 1:6500 BROOKTREE RD STE 100
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9272
Practice Address - Country:US
Practice Address - Phone:412-766-3232
Practice Address - Fax:412-766-4320
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34009226207RN0300X
PAOS014278207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2887041Medicaid
PA102093511Medicaid
WV3810012654Medicaid
WV3810012654Medicaid
OHBA4232931Medicare PIN
PA5008749OtherCIGNA
OH2887041Medicaid
WV3810012654Medicaid
PA1569619OtherGATEWAY
PA1020935110001Medicaid
PA129470HYPMedicare PIN