Healthcare Provider Details

I. General information

NPI: 1861123481
Provider Name (Legal Business Name): ISAAC B SAMPSON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2022
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 DWIGHT RD STE 104
LONGMEADOW MA
01106-1765
US

IV. Provider business mailing address

280 CHESTNUT ST FL 2
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 413-795-4555
  • Fax: 413-794-9448
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA100133
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: