Provider Demographics
NPI:1699713792
Name:UTER, SAMUEL ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:ANTHONY
Last Name:UTER
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:PO BOX 26246
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-6246
Mailing Address - Country:US
Mailing Address - Phone:718-604-5574
Mailing Address - Fax:718-604-5527
Practice Address - Street 1:1110 EASTERN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-4845
Practice Address - Country:US
Practice Address - Phone:718-221-3462
Practice Address - Fax:718-735-3581
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200231207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01842277Medicaid
NYA400015227Medicare PIN
NYI23680Medicare UPIN