Provider Demographics
NPI:1801898309
Name:AMILL-ACOSTA, SAMUEL A (MD, FCCP)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:A
Last Name:AMILL-ACOSTA
Suffix:
Gender:M
Credentials:MD, FCCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E36 CALLE HERNANDEZ CARRION
Mailing Address - Street 2:URB ATENAS
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-4622
Mailing Address - Country:US
Mailing Address - Phone:787-884-4478
Mailing Address - Fax:787-884-4495
Practice Address - Street 1:E36 CALLE HERNANDEZ CARRION
Practice Address - Street 2:URB ATENAS
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-4622
Practice Address - Country:US
Practice Address - Phone:787-884-4478
Practice Address - Fax:787-884-4495
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6112207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRAA1366485OtherFEDERAL NARCOTICS LICENSE
PR05947DM7OtherPR NARCOTICS LICENSE
PR6112OtherPHYSICIAN LICENSE
PR6112OtherPHYSICIAN LICENSE
PR05947DM7OtherPR NARCOTICS LICENSE