Provider Demographics
NPI:1881886257
Name:NEWBEGIN-FRACTION, SAMANTHA L (PA-C)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:L
Last Name:NEWBEGIN-FRACTION
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 W DIAMOND AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-1417
Mailing Address - Country:US
Mailing Address - Phone:540-303-0337
Mailing Address - Fax:
Practice Address - Street 1:818 W DIAMOND AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-1417
Practice Address - Country:US
Practice Address - Phone:540-303-0337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC05728363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC05728OtherMARYLAND BOARD OF PHYSICIANS