Provider Demographics
NPI:1427092956
Name:MORRIS, SAMUEL DAVID (MD)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:DAVID
Last Name:MORRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:S
Other - Middle Name:DAVID
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:101 MARCLEY DR
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-2977
Mailing Address - Country:US
Mailing Address - Phone:304-263-8911
Mailing Address - Fax:304-263-9450
Practice Address - Street 1:101 MARCLEY DR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-2977
Practice Address - Country:US
Practice Address - Phone:304-263-8911
Practice Address - Fax:304-263-9450
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12716207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVC10269OtherRAILROAD GROUP
WV9930421OtherMEDICARE GROUP NUMBER
WV080020708OtherRAILROAD INDIVIDUAL ID#
WVMO0522433Medicare PIN
WVC10269OtherRAILROAD GROUP