Provider Demographics
NPI:1649275272
Name:KURIEN, SAM (MD)
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:KURIEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5241 BUFFALO RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16510-2391
Mailing Address - Country:US
Mailing Address - Phone:814-877-5100
Mailing Address - Fax:814-877-5121
Practice Address - Street 1:5241 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16510-2391
Practice Address - Country:US
Practice Address - Phone:814-877-5100
Practice Address - Fax:814-877-5121
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072883L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3729977OtherAETNA
PA926359OtherBLUE SHIELD
PA159482OtherUNISON
PA0018460530005Medicaid
NY02160194OtherNY MEDICAL ASSISTANCE
PA219101OtherUPMC
PAP002483OtherGATEWAY
NY00026759902OtherUNIVERA
PAP00170502OtherRR MEDICARE
PA3729977OtherAETNA
PAP00170502OtherRR MEDICARE