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Individual

SAMSON G VIMALANANDA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1610 ROUTE 88 FL 3, BRICK, NJ 08724-3018
(732) 295-6543
Mailing address
120 SISTER PIERRE DR, SUITE 403, TOWSON, MA 21204
(410) 827-6408
(443) 279-0537

Taxonomy

Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
25MA10657200
NJ
2084P0800X
Psychiatry Physician
D20273
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0019
BSDC
01
096890
MHN
01
1023561
CIGN
01
150N131G
MBMD
01
221073
KAIS
01
253557
COMP
01
42225312
BSMD
01
461905000
MAGE
01
595882
MAMS
01
PVPB76641
APS
Enumeration date
06/02/2006
Last updated
07/28/2022
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