Individual
DR. SAMUEL T DETWILER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2323 MEMORIAL AVE STE 10, LYNCHBURG, VA 24501-2652
(434) 200-5200
(434) 200-5200
Mailing address
7126 FAIRWAY DR, BUTLER, PA 16001-8596
(724) 256-6960
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0102209331
VA
207Q00000X
Family Medicine Physician
34-00-7985
OH
207Q00000X
Family Medicine Physician
OS016525
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000285856
UNICARE-LIFE AND HEALTH
OH
05
—
2393299
—
OH
01
—
4489898
CIGNA
OH
01
—
753111223027
CARESOURCE
OH
01
—
J07985
SUMMACARE HEALTH PLAN
OH
01
—
P006463
GATEWAY HEALTH PLAN OF OH
OH
Enumeration date
10/20/2005
Last updated
08/08/2025
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