Provider Demographics
NPI:1588694160
Name:SAMITT, JOEL L (DO)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:L
Last Name:SAMITT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 398
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17508-0398
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:377 W MAIN ST
Practice Address - Street 2:SUITE100
Practice Address - City:LEOLA
Practice Address - State:PA
Practice Address - Zip Code:17540-1760
Practice Address - Country:US
Practice Address - Phone:717-656-6122
Practice Address - Fax:717-656-0142
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002216L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0041591OtherKEYSTONE
PA0006082170005Medicaid
4597687OtherAETNA
P002411OtherGATEWAY
000041591OtherBLUE SHIELD
50051237OtherBLUE CROSS
P00257504OtherRR MEDICARE
PA041591UFWMedicare ID - Type Unspecified
PA0006082170005Medicaid