Healthcare Provider Details

I. General information

NPI: 1073914180
Provider Name (Legal Business Name): SAMANTHA GAMBLER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAMANTHA NAVARRO

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 ROUTE 715 STE 102
BRODHEADSVILLE PA
18322-7101
US

IV. Provider business mailing address

111 ROUTE 715 STE 102
BRODHEADSVILLE PA
18322-7101
US

V. Phone/Fax

Practice location:
  • Phone: 272-212-0420
  • Fax:
Mailing address:
  • Phone: 717-471-9235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA057138
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: