Provider Demographics
NPI:1992798219
Name:SAMUEL, CHRISTOPHER J (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:J
Last Name:SAMUEL
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 1:12500 WILLOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-6393
Mailing Address - Country:US
Mailing Address - Phone:240-964-7000
Mailing Address - Fax:
Practice Address - Street 1:10455 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-7046
Practice Address - Country:US
Practice Address - Phone:814-623-3524
Practice Address - Fax:814-624-0646
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD062329L207L00000X
MDD0088742207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016540450004Medicaid
PA0016540450004Medicaid
PA544506Medicare ID - Type Unspecified