Provider Demographics
NPI:1427062207
Name:MAHAFFEY, SAMUEL M (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:M
Last Name:MAHAFFEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:CHILDRENS SURGICAL SPECIALTY GROUP
Mailing Address - Street 2:PO BOX 631617
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21263-1617
Mailing Address - Country:US
Mailing Address - Phone:757-668-7703
Mailing Address - Fax:757-668-8860
Practice Address - Street 1:601 CHILDRENS LN
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1910
Practice Address - Country:US
Practice Address - Phone:757-668-7703
Practice Address - Fax:757-668-8860
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01012376102086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1702645OtherUNITED HEATLH CARE
VA2134227OtherMAMSI/OPTIMUM CHOICE
VA2134227OtherALLIANCE & MDIPA
VA3116108340002EOtherCIGNA
VA8953736OtherNORTH CAROLINA MEDICAID
VA174614OtherANTHEM BCBS
VA92534OtherOPTIMA/SENTARA HEALTH
VA3116108340002EOtherCIGNA
VAD65724Medicare UPIN