Provider Demographics
NPI:1093007056
Name:SICK-SAMUELS, ANNA C
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:C
Last Name:SICK-SAMUELS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:C
Other - Last Name:SICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:200 N WOLFE ST
Mailing Address - Street 2:ROOM 3150
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0011
Mailing Address - Country:US
Mailing Address - Phone:410-614-3917
Mailing Address - Fax:410-614-1491
Practice Address - Street 1:200 N WOLFE ST
Practice Address - Street 2:ROOM 3150
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0011
Practice Address - Country:US
Practice Address - Phone:410-614-3917
Practice Address - Fax:410-614-1491
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD457202208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics