Healthcare Provider Details

I. General information

NPI: 1750341574
Provider Name (Legal Business Name): SAMUEL SALEEB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GUTHRIE SQ
SAYRE PA
18840-1625
US

IV. Provider business mailing address

3241 WESTERN BRANCH BLVD STE A
CHESAPEAKE VA
23321-5260
US

V. Phone/Fax

Practice location:
  • Phone: 570-887-2530
  • Fax: 570-887-2904
Mailing address:
  • Phone: 757-686-3508
  • Fax: 757-686-0541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101267623
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number229698
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD463843
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number04-51813
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: