Healthcare Provider Details

I. General information

NPI: 1003809047
Provider Name (Legal Business Name): SAMUEL K CHOI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 08/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 PARK ST
HONESDALE PA
18431-1445
US

IV. Provider business mailing address

601 PARK ST
HONESDALE PA
18431-1445
US

V. Phone/Fax

Practice location:
  • Phone: 570-253-8100
  • Fax: 570-253-6445
Mailing address:
  • Phone: 570-253-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD035622L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: