Healthcare Provider Details

I. General information

NPI: 1184699886
Provider Name (Legal Business Name): JILL MARIE SAMALE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 PROSPECT ST UNIT 1
NANTUCKET MA
02554-4396
US

IV. Provider business mailing address

57 PROSPECT ST UNIT 1
NANTUCKET MA
02554-4396
US

V. Phone/Fax

Practice location:
  • Phone: 508-825-1000
  • Fax: 508-825-8272
Mailing address:
  • Phone: 508-825-1000
  • Fax: 508-825-8272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number221324
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: