Provider Demographics
NPI:1346240397
Name:VERDI, SAM D (PA-C)
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:D
Last Name:VERDI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:333 STATE ST STE 103
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1450
Mailing Address - Country:US
Mailing Address - Phone:814-877-7157
Mailing Address - Fax:814-877-2844
Practice Address - Street 1:100 FAIRFIELD DR
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:PA
Practice Address - Zip Code:16346-2130
Practice Address - Country:US
Practice Address - Phone:814-676-7932
Practice Address - Fax:814-676-7975
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA001129L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S14134Medicare UPIN
541816FOSMedicare ID - Type Unspecified