Healthcare Provider Details

I. General information

NPI: 1700927365
Provider Name (Legal Business Name): SAMANTHA TUTTAMORE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 06/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST NW
WASHINGTON DC
20010
US

IV. Provider business mailing address

9323 CEDAR LN
BETHESDA MD
20814-3974
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-5580
  • Fax:
Mailing address:
  • Phone: 773-220-7268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA030322
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberC0002757
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: