Provider Demographics
NPI:1316628837
Name:TRIANTIS, SAMSON PHILIP (PA)
Entity type:Individual
Prefix:
First Name:SAMSON
Middle Name:PHILIP
Last Name:TRIANTIS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8204 PRESCOTT GLEN PKWY
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-6931
Mailing Address - Country:US
Mailing Address - Phone:704-998-8835
Mailing Address - Fax:
Practice Address - Street 1:12319 N MOPAC EXPY STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2497
Practice Address - Country:US
Practice Address - Phone:512-694-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant