Provider Demographics
NPI:1669767562
Name:DIAL, SAMANTHA JANE (MD)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JANE
Last Name:DIAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 BARRA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9461
Mailing Address - Country:US
Mailing Address - Phone:207-282-5509
Mailing Address - Fax:207-294-3543
Practice Address - Street 1:46 BARRA RD STE 101
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9461
Practice Address - Country:US
Practice Address - Phone:207-282-5509
Practice Address - Fax:207-294-3543
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-1401512084N0400X
MEMD297352084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036140151Medicaid
IL036140151Medicaid