Provider Demographics
NPI:1912431529
Name:FLANAGAN, SAMANTHA P (DO)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:P
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 VALLEY GREEN LN STE 510
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2080
Mailing Address - Country:US
Mailing Address - Phone:484-324-7100
Mailing Address - Fax:484-324-7660
Practice Address - Street 1:120 VALLEY GREEN LN STE 510
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2080
Practice Address - Country:US
Practice Address - Phone:484-324-7100
Practice Address - Fax:484-324-7660
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS019797207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine