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1942837950

NPI Code Detail

MEDICARE: GABRIEL SAMPOGNARO MD

MEDICARE: GABRIEL SAMPOGNARO 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	390200000X	Student in an Organized Health Care Education/Training Program
2	207X00000X	Orthopaedic Surgery Physician	351312	LA
3	207X00000X	Orthopaedic Surgery Physician	34906	MS

General Provider Information

NPI Number	:	1942837950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIEL SAMPOGNARO MD

Provider Business Mailing Address
First Line	:	1325 E FORTIFICATION ST
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39202-2442
Country	:	US
Telephone Number	:	601-354-4488
Fax Number	:	601-354-4488

Provider Business Practice Location Address
First Line	:	1325 E FORTIFICATION ST
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39202-2442
Country	:	US
Telephone Number	:	601-354-4488
Fax Number	:	601-354-4488

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

Provider Enumeration Date	:	03/27/2020
Last Update Date	:	06/05/2026

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Directions to “ GABRIEL SAMPOGNARO MD” Practice Location

Language	Start Address	Practice Location

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