Healthcare Provider Details

I. General information

NPI: 1013811132
Provider Name (Legal Business Name): SAMANTHA NOELLE FRAVEL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 DEFENSE HWY STE 302
ANNAPOLIS MD
21401-8926
US

IV. Provider business mailing address

6516 W GRACE ST
RICHMOND VA
23226-2836
US

V. Phone/Fax

Practice location:
  • Phone: 410-449-2060
  • Fax:
Mailing address:
  • Phone: 804-815-0607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0010767
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: