Healthcare Provider Details

I. General information

NPI: 1255794400
Provider Name (Legal Business Name): SAMANTHA BARTLING DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 VALLEY RD
MIDDLETOWN RI
02842-5237
US

IV. Provider business mailing address

102 VALLEY RD
MIDDLETOWN RI
02842-5237
US

V. Phone/Fax

Practice location:
  • Phone: 401-239-1800
  • Fax:
Mailing address:
  • Phone: 401-239-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberDO01232
License Number StateRI
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0102204946
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: