Healthcare Provider Details

I. General information

NPI: 1073174991
Provider Name (Legal Business Name): SAMANTHA J HARASZTI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 QUARTERMASTER CT
JEFFERSONVILLE IN
47130-3669
US

IV. Provider business mailing address

801 YORK ST
MANITOWOC WI
54220-4630
US

V. Phone/Fax

Practice location:
  • Phone: 812-282-8622
  • Fax: 812-282-4332
Mailing address:
  • Phone: 920-663-9008
  • Fax: 920-684-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number02008549A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number06193
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: