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General NPI Number Information
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NPI Number | 1750549044
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Entity Type | Individual
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Provider Name | SAMUELA EUDORA MANAGES MD
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Gender | Female
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Dates
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Enumeration Date | 05/23/2008
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Last Update Date | 10/19/2023
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Provider Practice Location Address
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Address Line | 151 EVERETT AVE
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City | CHELSEA
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State | MA
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Zip | 02150-1812
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Country | US
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Telephone | 617-884-8302
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 40
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City | CARIBOU
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State | ME
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Zip | 04736-0040
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Country | US
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Telephone | 207-498-2359
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Fax | 207-498-3947
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 017911
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | MD17911
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License Number State | ME
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