Healthcare Provider Details

I. General information

NPI: 1730421678
Provider Name (Legal Business Name): SAMANTHA PEARL ZUCKERMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2013
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST 1ST FLOOR PENN TOWER
PHILADELPHIA PA
19104-4238
US

IV. Provider business mailing address

3400 SPRUCE ST 1ST FLOOR PENN TOWER
PHILADELPHIA PA
19104-4238
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-3264
  • Fax:
Mailing address:
  • Phone: 215-662-3264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number26NJ01010600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD455287
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: