MEDICARE: LLERAS A SAMUELS MD

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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	MD050516L	PA

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	:	1225026487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LLERAS A SAMUELS MD

Provider Business Mailing Address
First Line	:	2450 W HUNTING PARK AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19129-1302
Country	:	US
Telephone Number	:	215-707-5864
Fax Number	:	215-707-6864

Provider Business Practice Location Address
First Line	:	8815 GERMANTOWN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-2722
Country	:	US
Telephone Number	:	215-707-5864
Fax Number	:	215-707-6867

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	04/09/2018

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