Healthcare Provider Details

I. General information

NPI: 1487875449
Provider Name (Legal Business Name): SAMANTHA RAWLINS PHYSICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GRAND CONCOURSE 5TH FL.OBGYN ADMINISTRATION
BRONX NY
10457-7606
US

IV. Provider business mailing address

4045 WICKHAM AVE
BRONX NY
10466-2232
US

V. Phone/Fax

Practice location:
  • Phone: 718-239-8383
  • Fax: 718-239-8360
Mailing address:
  • Phone: 718-239-8383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number119424
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: