Healthcare Provider Details

I. General information

NPI: 1790428407
Provider Name (Legal Business Name): SAMANTHA WARGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MELLON WAY
LATROBE PA
15650-1197
US

IV. Provider business mailing address

1 MELLON WAY
LATROBE PA
15650-1197
US

V. Phone/Fax

Practice location:
  • Phone: 724-537-1650
  • Fax: 724-532-6047
Mailing address:
  • Phone: 724-537-1650
  • Fax: 724-532-6047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS025694
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: