Healthcare Provider Details

I. General information

NPI: 1780567578
Provider Name (Legal Business Name): SAMUEL WINFREY PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MEDICAL PKWY
ANNAPOLIS MD
21401-3773
US

IV. Provider business mailing address

210 OHIO RIVER BLVD
BADEN PA
15005-1914
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-4150
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: