=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588694160
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOEL L SAMITT DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2006
-----------------------------------------------------
Last Update Date | 03/26/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 377 W MAIN ST SUITE100
-----------------------------------------------------
City | LEOLA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17540-1760
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-656-6122
-----------------------------------------------------
Fax | 717-656-0142
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 398
-----------------------------------------------------
City | BROWNSTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17508-0398
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | OS002216L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------