Provider Demographics
NPI:1467652826
Name:ZYGLER, SAMUEL (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:ZYGLER
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 1:2524 FARRINGDON RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-2543
Mailing Address - Country:US
Mailing Address - Phone:410-484-8254
Mailing Address - Fax:410-484-4416
Practice Address - Street 1:2524 FARRINGDON RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-2543
Practice Address - Country:US
Practice Address - Phone:410-484-8254
Practice Address - Fax:410-484-4416
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD35606207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD35606OtherSTATE LICENSE
MDM25593OtherMARYLAND DRUG CONTROL
AZ2491164OtherDEA
B69886Medicare UPIN