Healthcare Provider Details

I. General information

NPI: 1922204601
Provider Name (Legal Business Name): JOSE SAMSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1799 JOCKEYS WAY
YARDLEY PA
19067-3972
US

IV. Provider business mailing address

1799 JOCKEYS WAY
YARDLEY PA
19067-3972
US

V. Phone/Fax

Practice location:
  • Phone: 215-497-0728
  • Fax:
Mailing address:
  • Phone: 215-497-0728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD038428L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier30060118
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerKEYSTONE MERCY
# 2
Identifier000953390 0005
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 3
Identifier0022565000
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerIBX
# 4
Identifier30060272
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerKEYSTONE MERCY-LOWER BUCKS GROUP
# 5
Identifier413532
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK BLUE SHIELD
# 6
IdentifierP00718793
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerRAILROAD MEDICARE
# 7
IdentifierP00774660
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerRR MEDICARE - BUCKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: