Healthcare Provider Details

I. General information

NPI: 1205201274
Provider Name (Legal Business Name): SAMANTHA RAE TWIDDY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAMANTHA GREEN PA-C

II. Dates (important events)

Enumeration Date: 12/02/2015
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3730 TABS DR
UNIONTOWN OH
44685-9562
US

IV. Provider business mailing address

2600 6TH ST SW
CANTON OH
44710-1702
US

V. Phone/Fax

Practice location:
  • Phone: 330-568-0618
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.004160
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: