Provider Demographics
NPI:1720716046
Name:VOGT, SAMANTHA (DNP)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:VOGT
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:150 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FAWN GROVE
Mailing Address - State:MD
Mailing Address - Zip Code:17321-2820
Mailing Address - Country:US
Mailing Address - Phone:570-855-4940
Mailing Address - Fax:
Practice Address - Street 1:208 PLUMTREE RD STE C
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6058
Practice Address - Country:US
Practice Address - Phone:410-420-9836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-13
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP029392363LG0600X
MDR215207363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology