Provider Demographics
NPI:1053602375
Name:HOUSER, SAMANTHA ELIZABETH (DO)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ELIZABETH
Last Name:HOUSER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 FAR HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2207
Mailing Address - Country:US
Mailing Address - Phone:937-435-6222
Mailing Address - Fax:
Practice Address - Street 1:5701 FAR HILLS AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-2207
Practice Address - Country:US
Practice Address - Phone:937-435-6222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.011704207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0120633Medicaid
OH2147224OtherGROUP MEDICAID
OH9271701OtherGROUP MEDICARE