MEDICARE: MS. ASHLEY ANN SAMUEL 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
1	363AM0700X	Medical Physician Assistant	MA057934	PA

General Provider Information

NPI Number	:	1316317126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ASHLEY ANN SAMUEL PA-C

Provider Business Mailing Address
First Line	:	10800 KNIGHTS RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-4200
Country	:	US
Telephone Number	:	215-612-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	10800 KNIGHTS RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-4200
Country	:	US
Telephone Number	:	215-612-4000
Fax Number	:

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

Provider Enumeration Date	:	10/06/2015
Last Update Date	:	02/16/2026

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