Provider Demographics
NPI:1053385583
Name:SAMPSON, LAWRENCE NATHAN (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:NATHAN
Last Name:SAMPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:1 GUTHRIE SQ
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1625
Practice Address - Country:US
Practice Address - Phone:570-888-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205449-12086S0129X
PAMD056226L2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC8362OtherRR MEDICARE GROUP
NYP00313956OtherRR MEDICARE PIN
PA0015361120001Medicaid
PA770002511OtherRR MEDICARE PIN
PACC9269OtherRR MEDICARE GROUP
PAGU039818OtherPA MEDICARE GROUP
NY01575699Medicaid
PACC9269OtherRR MEDICARE GROUP
PA0015361120001Medicaid
NY01575699Medicaid