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NPI Code Detail

MEDICARE: RICHARD A SAMPONG PA-C

MEDICARE: RICHARD A SAMPONG PA-C
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
1363A00000XPhysician AssistantC0004500MD

General Provider Information

NPI Number : 1154614394
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD A SAMPONG PA-C
Provider Business Mailing Address
First Line : 5000 COX RD
Second Line :
City : GLEN ALLEN
State : VA
Zip : 23060-9263
Country : US
Telephone Number : 804-968-5700
Fax Number : 804-217-7991
Provider Business Practice Location Address
First Line : 6201 ANNAPOLIS RD
Second Line :
City : LANDOVER HILLS
State : MD
Zip : 20784-1307
Country : US
Telephone Number : 301-276-3377
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2011
Last Update Date : 03/04/2019

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