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NPI Code Detail

MEDICARE: SAMUEL D KIDD

MEDICARE: SAMUEL D KIDD
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
1163W00000XRegistered NurseR182219MD

General Provider Information

NPI Number : 1619828381
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMUEL D KIDD
Provider Business Mailing Address
First Line : 20 S FRONT ST
Second Line :
City : NEW FREEDOM
State : PA
Zip : 17349-7952
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10803 FALLS RD
Second Line :
City : LUTHERVILLE
State : MD
Zip : 21093-4518
Country : US
Telephone Number : 443-997-3370
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2026
Last Update Date : 02/06/2026

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Directions to “ SAMUEL D KIDD ” Practice Location

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