MEDICARE: MERVYN SAMUEL 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	207V00000X	Obstetrics & Gynecology Physician	35035794	OH

General Provider Information

NPI Number	:	1356388581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERVYN SAMUEL MD

Provider Business Mailing Address
First Line	:	5910 CLEVELAND AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231
Country	:	US
Telephone Number	:	614-882-4343
Fax Number	:	614-882-4664

Provider Business Practice Location Address
First Line	:	5910 CLEVELAND AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231
Country	:	US
Telephone Number	:	614-882-4343
Fax Number	:	614-882-4664

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	07/08/2007

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