Provider Demographics
NPI:1083444392
Name:ANDERSON, SAMANTHA (PA-S)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 CHISWICK RD APT 3
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-5319
Mailing Address - Country:US
Mailing Address - Phone:719-651-6366
Mailing Address - Fax:
Practice Address - Street 1:ROBINSON HALL, 336 HUNTINGTON AVE
Practice Address - Street 2:#202
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-373-3195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program