Provider Demographics
NPI:1912911959
Name:SAMUEL, BARRY (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:SAMUEL
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:PO BOX 1029
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-1029
Mailing Address - Country:US
Mailing Address - Phone:831-747-7576
Mailing Address - Fax:650-226-3599
Practice Address - Street 1:1060 CONTINENTALS WAY APT 212
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-3181
Practice Address - Country:US
Practice Address - Phone:831-747-7576
Practice Address - Fax:650-226-3599
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA046343207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAY549TMedicare PIN
CAG66609Medicare UPIN
CAA549UMedicare PIN