Provider Demographics
NPI:1053546572
Name:LYNN H SAMUEL MD LLC
Entity type:Organization
Organization Name:LYNN H SAMUEL MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:H
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-316-5604
Mailing Address - Street 1:493 BLACKWELL ROAD
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2628
Mailing Address - Country:US
Mailing Address - Phone:540-316-5604
Mailing Address - Fax:540-316-5601
Practice Address - Street 1:493 BLACKWELL ROAD
Practice Address - Street 2:SUITE 101A
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2628
Practice Address - Country:US
Practice Address - Phone:540-316-5604
Practice Address - Fax:540-316-5601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-28
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044708207PE0005X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VADP4396OtherRR MEDICARE
VADP4396OtherRR MEDICARE