MEDICARE: WILNER SAMSON MD

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	207RN0300X	Nephrology Physician	041729	CT
2	207R00000X	Internal Medicine Physician	041729	CT

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	:	1215934658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILNER SAMSON MD

Provider Business Mailing Address
First Line	:	98 MAIN ST
Second Line	:
City	:	SOUTHINGTON
State	:	CT
Zip	:	06489-2500
Country	:	US
Telephone Number	:	860-276-5144
Fax Number	:	860-276-5148

Provider Business Practice Location Address
First Line	:	98 MAIN ST
Second Line	:
City	:	SOUTHINGTON
State	:	CT
Zip	:	06489-2500
Country	:	US
Telephone Number	:	860-276-5144
Fax Number	:	860-276-5148

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	02/26/2016

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