Provider Demographics
NPI:1699933887
Name:FISH, SAMANTHA HOPE (MD)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:HOPE
Last Name:FISH
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Gender:F
Credentials:MD
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Mailing Address - Street 1:100 E PENN SQ
Mailing Address - Street 2:9TH FLOOR NORTH TOWER
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3323
Mailing Address - Country:US
Mailing Address - Phone:267-425-9200
Mailing Address - Fax:267-425-9299
Practice Address - Street 1:3401 CIVIC CENTER BLVD
Practice Address - Street 2:CHILDRENS HOSPITAL OF PHILADELPHIA
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4319
Practice Address - Country:US
Practice Address - Phone:215-590-3630
Practice Address - Fax:215-590-3606
Is Sole Proprietor?:No
Enumeration Date:2008-05-25
Last Update Date:2019-04-11
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Provider Licenses
StateLicense IDTaxonomies
PAMD4477272080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1029139950001Medicaid