Healthcare Provider Details

I. General information

NPI: 1598775801
Provider Name (Legal Business Name): TILLY EFFIE DUNCAN-SAMPSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N EASTOWN RD
LIMA OH
45807-2268
US

IV. Provider business mailing address

4803 KITAMAT TRL
LIMA OH
45805-4163
US

V. Phone/Fax

Practice location:
  • Phone: 419-998-8214
  • Fax:
Mailing address:
  • Phone: 419-224-3892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.077031
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: