Provider Demographics
NPI:1750573820
Name:MILOSZ, SAMANTHA LEE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:LEE
Last Name:MILOSZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1019 W OAKLAND AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2357
Mailing Address - Country:US
Mailing Address - Phone:423-915-5000
Mailing Address - Fax:423-915-5045
Practice Address - Street 1:378 MARKETPLACE DR STE 5
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2361
Practice Address - Country:US
Practice Address - Phone:423-282-0751
Practice Address - Fax:423-282-1577
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00165800363AM0700X
NY011369-1363AM0700X
TN1649363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1750573820Medicaid
TN1512404Medicaid
TN103I979769Medicare PIN