MEDICARE: DR. WILLIAM SAMUAL DAVID MD PHD

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	2084N0400X	Neurology Physician	35502	MN

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	:	1750333605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM SAMUAL DAVID MD PHD

Provider Business Mailing Address
First Line	:	3215 IRVING AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-3319
Country	:	US
Telephone Number	:	612-873-2595
Fax Number	:	612-904-4270

Provider Business Practice Location Address
First Line	:	165 CAMBRIDGE ST
Second Line	:	MGH EMG/NEUROMUSCULAR UNIT 8TH FLOOR
City	:	BOSTON
State	:	MA
Zip	:	02114-2783
Country	:	US
Telephone Number	:	617-643-2085
Fax Number	:	617-726-2019

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	10/15/2012

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