Individual
SAMANTHA Y KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1627 SEYMOUR DR, SOUTH BOSTON, VA 24592-3447
(434) 575-1336
(434) 575-1349
Mailing address
1627 SEYMOUR DR, SOUTH BOSTON, VA 24592-3447
(434) 575-1336
(434) 572-2063
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101234104
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006738567
—
VA
01
—
246295
BCBS
VA
01
—
62490
OPTIMA
VA
Enumeration date
03/14/2006
Last updated
01/31/2020
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