Healthcare Provider Details

I. General information

NPI: 1609066471
Provider Name (Legal Business Name): DAVID E SAMUEL DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 WEST SPROUL ROAD SUITE 107
SPRINGFIELD PA
19064
US

IV. Provider business mailing address

196 WEST SPROUL ROAD SUITE 107
SPRINGFIELD PA
19064
US

V. Phone/Fax

Practice location:
  • Phone: 610-328-9122
  • Fax: 610-328-6219
Mailing address:
  • Phone: 610-328-9122
  • Fax: 610-328-6219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC003536L
License Number StatePA

VIII. Authorized Official

Name: DR. DAVID EMANUAEL SAMUEL
Title or Position: OWNER
Credential: DPM
Phone: 610-328-9122