Healthcare Provider Details

I. General information

NPI: 1861253791
Provider Name (Legal Business Name): ANNA BATES SAMSON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNA BATES SHINER PA

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 WARWICK BLVD STE 410
NEWPORT NEWS VA
23601-2548
US

IV. Provider business mailing address

856 J CLYDE MORRIS BLVD STE A
NEWPORT NEWS VA
23601-1318
US

V. Phone/Fax

Practice location:
  • Phone: 757-534-5200
  • Fax: 757-534-5830
Mailing address:
  • Phone: 757-316-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110010267
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: