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NPI Code Detail

MEDICARE: SAMANTHA DARE GULLEDGE PA

MEDICARE: SAMANTHA DARE GULLEDGE PA
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 Assistant0010-12847NC

General Provider Information

NPI Number : 1740991504
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMANTHA DARE GULLEDGE PA
Provider Business Mailing Address
First Line : PO BOX 23329
Second Line :
City : NEW YORK
State : NY
Zip : 10087-3329
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1099 MEDICAL CENTER DR
Second Line : SUITES 100 AND 201
City : WILMINGTON
State : NC
Zip : 28401
Country : US
Telephone Number : 910-251-9994
Fax Number : 910-763-4666
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2022
Last Update Date : 05/04/2026

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Directions to “ SAMANTHA DARE GULLEDGE PA” Practice Location

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