Healthcare Provider Details

I. General information

NPI: 1497435093
Provider Name (Legal Business Name): SAMUEL BAIR PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4259 W SWAMP ROAD SUITE 108
DOYESTOWN PA
18902
US

IV. Provider business mailing address

PO BOX 824320
PHILADELPHIA PA
19182-4320
US

V. Phone/Fax

Practice location:
  • Phone: 215-863-8363
  • Fax: 215-230-3861
Mailing address:
  • Phone: 215-863-8363
  • Fax: 215-230-3861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA007058
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: