Individual
SAMANTHA LEA MCCANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
593 EDDY ST, PROVIDENCE, RI 02903-4923
(401) 444-5943
Mailing address
593 EDDY ST, PROVIDENCE, RI 02903-4923
(401) 444-5943
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA00887
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05-0483739
TAX ID
RI
Enumeration date
06/02/2016
Last updated
10/27/2022
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