MEDICARE: SAMUEL THAMPI 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	208VP0000X	Pain Medicine Physician	220673	NY
2	208VP0014X	Interventional Pain Medicine Physician	220673	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215932447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL THAMPI M.D.

Provider Business Mailing Address
First Line	:	14 BELAIR DR
Second Line	:
City	:	OLD BETHPAGE
State	:	NY
Zip	:	11804-1445
Country	:	US
Telephone Number	:	516-382-7808
Fax Number	:	631-207-8567

Provider Business Practice Location Address
First Line	:	33 WALT WHITMAN RD
Second Line	:	STE-100
City	:	HUNTINGTON STATION
State	:	NY
Zip	:	11746-3640
Country	:	US
Telephone Number	:	631-470-2021
Fax Number	:	631-207-8567

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	12/12/2012

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