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NPI Code Detail

MEDICARE: SAMANTHA RAE TWIDDY PA-C

MEDICARE: SAMANTHA RAE TWIDDY 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 Assistant50.004160OH

General Provider Information

NPI Number : 1205201274
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA RAE TWIDDY PA-C
Provider Business Mailing Address
First Line : 2600 6TH ST SW
Second Line :
City : CANTON
State : OH
Zip : 44710-1702
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3730 TABS DR
Second Line :
City : UNIONTOWN
State : OH
Zip : 44685-9562
Country : US
Telephone Number : 330-568-0618
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/02/2015
Last Update Date : 12/18/2025

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