Healthcare Provider Details

I. General information

NPI: 1316941065
Provider Name (Legal Business Name): SAMUEL FLEISHMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 02/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3308 MELROSE RD
FAYETTEVILLE NC
28304-1604
US

IV. Provider business mailing address

3308 MELROSE RD
FAYETTEVILLE NC
28304-1604
US

V. Phone/Fax

Practice location:
  • Phone: 910-615-3200
  • Fax: 910-615-3201
Mailing address:
  • Phone: 910-615-3200
  • Fax: 910-615-3201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number9500902
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number9500902
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number9500902
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: