MEDICARE: SAMUEL LUIS BARRON DO

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	207Q00000X	Family Medicine Physician	OT025290	PA

General Provider Information

NPI Number	:	1356273981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL LUIS BARRON DO

Provider Business Mailing Address
First Line	:	1150 BIBBS RD APT 10
Second Line	:
City	:	VOORHEES
State	:	NJ
Zip	:	08043-2154
Country	:	US
Telephone Number	:	915-637-8528
Fax Number	:

Provider Business Practice Location Address
First Line	:	8815 GERMANTOWN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-2722
Country	:	US
Telephone Number	:	215-248-8145
Fax Number	:

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

Provider Enumeration Date	:	05/29/2026
Last Update Date	:	05/29/2026

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