Individual
SCOTT A. SAMPLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1001 NEWMAN RD, NEW BERN, NC 28562-5253
(252) 635-6777
(252) 634-3183
Mailing address
PO BOX 68, POLLOCKSVILLE, NC 28573-0068
(252) 635-6777
(252) 634-3183
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
2020-00954
NC
207RI0011X
Interventional Cardiology Physician
MED-PHYS-LIC-10527
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000096785
BCBS PIN
MT
01
—
0072607
MDCD PIN
MT
01
—
119419400
MDCD PIN
WY
Enumeration date
10/23/2006
Last updated
04/02/2020
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