MEDICARE: DR. RONALD C SAMUELS MD, MPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	75654	MA
2	208000000X	Pediatrics Physician	183732	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023101250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD C SAMUELS MD, MPH

Provider Business Mailing Address
First Line	:	3411 WAYNE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-2509
Country	:	US
Telephone Number	:	917-801-5981
Fax Number	:	718-405-5260

Provider Business Practice Location Address
First Line	:	3411 WAYNE AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-2509
Country	:	US
Telephone Number	:	718-741-2507
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/13/2023

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