Provider Demographics
NPI:1811983935
Name:CHRISTIAN, SAMUEL JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:JOSEPH
Last Name:CHRISTIAN
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 1:478 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-2610
Mailing Address - Country:US
Mailing Address - Phone:419-447-9313
Mailing Address - Fax:419-447-9920
Practice Address - Street 1:478 W MARKET ST
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-2610
Practice Address - Country:US
Practice Address - Phone:419-447-9313
Practice Address - Fax:419-447-9920
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6184207Q00000X
OH61894208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH61894OtherOHIO LICENCE
OH846240Medicaid
OH0695841Medicare ID - Type UnspecifiedPROVIDER
OHC03773Medicare UPIN