Individual
DR. THOMAS SAMUELSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1155 E MOUNTAIN BLVD, WILKES BARRE, PA 18702-7906
(570) 808-7916
(570) 808-6006
Mailing address
100 NORTH ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 271-6144
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MD043615L
PA
207VG0400X
Gynecology Physician
MD043615L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001234828
—
PA
Enumeration date
01/13/2006
Last updated
08/10/2020
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