MEDICARE: JESSICA SAMPIAS CRAIG M.D.

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	208000000X	Pediatrics Physician	D0081575	MD
2	207R00000X	Internal Medicine Physician	D0081575	MD

General Provider Information

NPI Number	:	1124384086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA SAMPIAS CRAIG M.D.

Provider Business Mailing Address
First Line	:	5235 KING AVE
Second Line	:
City	:	ROSEDALE
State	:	MD
Zip	:	21237-4068
Country	:	US
Telephone Number	:	443-730-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	5235 KING AVE
Second Line	:
City	:	ROSEDALE
State	:	MD
Zip	:	21237-4068
Country	:	US
Telephone Number	:	443-730-2020
Fax Number	:

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

Provider Enumeration Date	:	04/05/2012
Last Update Date	:	04/17/2019

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