MEDICARE: DAVID E SAMUEL DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	SC003536L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	480021835	OTHER	PA	PALMETTO/RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3323	OTHER	PA	ELDER HEALTH
2	0549291000	OTHER	PA	KEYSTONE HEALTH PLAN EAST
4	4973770001	OTHER	PA	NHIC/DMERC
5	1643217	OTHER	PA	BLUE SHIELD GROUP NUMBER
6	712999	OTHER	PA	BLUE SHIELD
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	1010163	OTHER	PA	KEYSTONE MERCY
9	2317760000	OTHER	PA	KEYSTONE HEALTH GROUP NUM

General Provider Information

NPI Number	:	1053491837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID E SAMUEL DPM

Provider Business Mailing Address
First Line	:	196 W SPROUL RD STE 107
Second Line	:
City	:	SPRINGFIELD
State	:	PA
Zip	:	19064-2045
Country	:	US
Telephone Number	:	610-328-9122
Fax Number	:	610-328-6219

Provider Business Practice Location Address
First Line	:	196 W SPROUL RD STE 107
Second Line	:
City	:	SPRINGFIELD
State	:	PA
Zip	:	19064-2045
Country	:	US
Telephone Number	:	610-328-9122
Fax Number	:	610-328-6219

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	01/14/2020

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Directions to “ DAVID E SAMUEL DPM” Practice Location

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