Provider Demographics
NPI:1841871787
Name:CERMIGNANO, SAMANTHA LYN (MD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:LYN
Last Name:CERMIGNANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SAMANTHA
Other - Middle Name:LYN
Other - Last Name:INNIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:333 N. SANTA ROSA ST
Mailing Address - Street 2:CCF-F3725
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-3108
Mailing Address - Country:US
Mailing Address - Phone:210-704-3910
Mailing Address - Fax:210-704-4922
Practice Address - Street 1:333 N. SANTA ROSA ST
Practice Address - Street 2:CCF-F3725
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3108
Practice Address - Country:US
Practice Address - Phone:210-704-3910
Practice Address - Fax:210-704-4922
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXV2705208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics