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General NPI Number Information
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NPI Number | 1053546572
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Entity Type | Organization
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Legal Business Name | LYNN H SAMUEL MD LLC
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Dates
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Enumeration Date | 05/28/2009
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Last Update Date | 01/04/2010
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Provider Practice Location Address
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Address Line | 493 BLACKWELL ROAD SUITE 101A
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City | WARRENTON
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State | VA
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Zip | 20186-2628
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Country | US
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Telephone | 540-316-5604
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Fax | 540-316-5601
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Provider Business Mailing Address
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Address Line | 493 BLACKWELL ROAD SUITE 101A
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City | WARRENTON
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State | VA
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Zip | 20186-2628
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Country | US
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Telephone | 540-316-5604
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Fax | 540-316-5601
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Authorized Official
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Title or Position | OWNER
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Name | LYNN H SAMUEL
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Credential | MD
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Telephone | 540-316-5604
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 0101044708
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207PE0005X
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Taxonomy Name | Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
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License Number | 0101044708
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License Number State | VA
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