Provider Demographics
NPI:1053445130
Name:SAMUELS, BARBARA NAN (MD)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:NAN
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 MAMMOTH RD STE 1
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03109-4133
Mailing Address - Country:US
Mailing Address - Phone:603-663-8285
Mailing Address - Fax:
Practice Address - Street 1:275 MAMMOTH RD STE 1
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03109-4133
Practice Address - Country:US
Practice Address - Phone:036-663-8285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222757-12080P0006X
NC275142080P0006X
HIMD-130922080P0006X
NH181972080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY077ZN1OtherEMPIRE BC
NY143321OtherGHI/HMO
NY9161394OtherAETNA
NY03159886Medicaid
NY9042528OtherMVP HEALTHCARE
NC5908117Medicaid
NY100127000093OtherFIDELIS
NC147AAOtherBCBS NC
NYPRC200203901OtherCDPHP
NCNCE6130322Medicare PIN
NY9161394OtherAETNA