Provider Demographics
NPI:1053491837
Name:SAMUEL, DAVID E (DPM)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:E
Last Name:SAMUEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:196 W SPROUL RD STE 107
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-2045
Mailing Address - Country:US
Mailing Address - Phone:610-328-9122
Mailing Address - Fax:610-328-6219
Practice Address - Street 1:196 W SPROUL RD STE 107
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2045
Practice Address - Country:US
Practice Address - Phone:610-328-9122
Practice Address - Fax:610-328-6219
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003536L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3323OtherELDER HEALTH
PA0549291000OtherKEYSTONE HEALTH PLAN EAST
PA480021835OtherPALMETTO/RR MEDICARE
PA4973770001OtherNHIC/DMERC
PA1643217OtherBLUE SHIELD GROUP NUMBER
PA712999OtherBLUE SHIELD
PA00130001000004Medicaid
PA1010163OtherKEYSTONE MERCY
PA2317760000OtherKEYSTONE HEALTH GROUP NUM
PA232819621OtherEIN NUMBER