MEDICARE: DR. JAHAN D SAMPSON DC

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	111N00000X	Chiropractor	S2070	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	614021	OTHER	MD	CAREFIRST
2	10436136	OTHER	MD	CAQH

General Provider Information

NPI Number	:	1487652202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAHAN D SAMPSON DC

Provider Business Mailing Address
First Line	:	9601 PULASKI PARK DR
Second Line	:	SUITE 416
City	:	BALTIMORE
State	:	MD
Zip	:	21220-1409
Country	:	US
Telephone Number	:	410-933-5678
Fax Number	:	410-933-1823

Provider Business Practice Location Address
First Line	:	2953 EMMORTON RD
Second Line	:
City	:	ABINGDON
State	:	MD
Zip	:	21009-1631
Country	:	US
Telephone Number	:	410-515-6785
Fax Number	:	410-515-6757

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

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	05/28/2015

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