Provider Demographics
NPI:1124634142
Name:SAMSA, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SAMSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 PAXTON RD
Mailing Address - Street 2:
Mailing Address - City:EASTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44095-1022
Mailing Address - Country:US
Mailing Address - Phone:440-488-8998
Mailing Address - Fax:
Practice Address - Street 1:232 PAXTON RD
Practice Address - Street 2:
Practice Address - City:EASTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44095-1022
Practice Address - Country:US
Practice Address - Phone:440-488-8998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0220052OtherODJFS