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Individual
MR. SAMUEL DEAN DETWEILER
Active
Individual
MR. SAMUEL DEAN DETWEILER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
157873
NY
207Q00000X
Family Medicine Physician
Primary
157873
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000419006006
BS PROVIDER NUMBER
NY
01
—
040426006943
FIDELIS
NY
01
—
10000485
CDPHP
NY
01
—
77787
MVP
NY
Enumeration date
02/08/2007
Last updated
09/21/2010
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