Healthcare Provider Details

I. General information

NPI: 1811936719
Provider Name (Legal Business Name): SAMUEL HENRY FISTEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANDSTUHL REGIONAL MEDICAL CENTER ATTN: MCEUL-P (DPALS), CMR 402
APO AE
09180
DE

IV. Provider business mailing address

LANDSTUHL REGIONAL MEDICAL CENTER ATTN: MCEUL-DCCS (CREDENTIALS), CMR 402
APO AE
09180
DE

V. Phone/Fax

Practice location:
  • Phone: 011496371867842
  • Fax: 011496371867502
Mailing address:
  • Phone: 011496371868839
  • Fax: 011496371866133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD30774
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: