Provider Demographics
NPI:1740366970
Name:PAYNE, SAMUEL KIRK (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:KIRK
Last Name:PAYNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 LOFTIS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-3069
Mailing Address - Country:US
Mailing Address - Phone:757-873-9400
Mailing Address - Fax:757-873-9420
Practice Address - Street 1:1051 LOFTIS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3069
Practice Address - Country:US
Practice Address - Phone:757-873-9400
Practice Address - Fax:757-873-9420
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085153207RH0002X
VA0101047339207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1740366970Medicaid
MI1740366970Medicaid
MIM08620056Medicare PIN
MIN66660009Medicare PIN