Individual
FANIA SAMUELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10160 BUSTLETON AVE, SUITE C, PHILADELPHIA, PA 19116-3749
(215) 671-3920
(215) 671-3939
Mailing address
PO BOX 8500-6335, PHILADELPHIA, PA 19178-0001
(215) 671-3920
(215) 671-3939
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
MD042597E
PA
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
MD042597E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001549406
—
PA
05
—
0015494060015
—
PA
01
—
0833050000
KEYSTONE IBC
PA
01
—
30133381
KEYSTONE FIRST
PA
01
—
806944
HIGHMARK BLUE SHIELD
PA
01
—
8692853
AETNA
PA
Enumeration date
02/16/2006
Last updated
01/17/2014
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