MEDICARE: MATHEW.P.SAMUEL,MD PSC

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	174400000X	Specialist	30450	KY

General Provider Information

NPI Number	:	1174741425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATHEW.P.SAMUEL,MD PSC

Provider Business Mailing Address
First Line	:	2154 CARTER AVE STE D
Second Line	:
City	:	ASHLAND
State	:	KY
Zip	:	41101-7739
Country	:	US
Telephone Number	:	606-325-9224
Fax Number	:

Provider Business Practice Location Address
First Line	:	2154 CARTER AVE STE D
Second Line	:
City	:	ASHLAND
State	:	KY
Zip	:	41101-7739
Country	:	US
Telephone Number	:	606-325-9224
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MATHEW P SAMUEL
Credential	:	M.D
Telephone Number	:	606-325-9224

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	10/12/2007

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