Provider Demographics
NPI:1194463729
Name:ABBOTT, SAMANTHA KAREN (PA)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:KAREN
Last Name:ABBOTT
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3000 NEW BERN AVE STE 1130
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1245
Mailing Address - Country:US
Mailing Address - Phone:407-951-2159
Mailing Address - Fax:
Practice Address - Street 1:2827 LYNDHURST AVE STE 203
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4145
Practice Address - Country:US
Practice Address - Phone:336-794-8624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2025-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-12506363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant