Provider Demographics
NPI:1215934658
Name:SAMSON, WILNER (MD)
Entity type:Individual
Prefix:
First Name:WILNER
Middle Name:
Last Name:SAMSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-2500
Mailing Address - Country:US
Mailing Address - Phone:860-276-5144
Mailing Address - Fax:860-276-5148
Practice Address - Street 1:98 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-2500
Practice Address - Country:US
Practice Address - Phone:860-276-5144
Practice Address - Fax:860-276-5148
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT041729207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1417296Medicaid
CT390000171Medicare PIN
CT1417296Medicaid