Healthcare Provider Details

I. General information

NPI: 1164482071
Provider Name (Legal Business Name): MICHAEL JOHN SAMSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 05/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 ELM ST
TOPSHAM ME
04086
US

IV. Provider business mailing address

44 ELM ST
TOPSHAM ME
04086
US

V. Phone/Fax

Practice location:
  • Phone: 207-725-4455
  • Fax: 207-725-4861
Mailing address:
  • Phone: 207-725-4455
  • Fax: 207-725-4861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number015351
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: