Provider Demographics
NPI:1447017561
Name:SAMEDY, LOURDES (MEDICAL CASE)
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:
Last Name:SAMEDY
Suffix:
Gender:F
Credentials:MEDICAL CASE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 CRAWFORD ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02121-1089
Mailing Address - Country:US
Mailing Address - Phone:857-244-1452
Mailing Address - Fax:
Practice Address - Street 1:123 CRAWFORD ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02121-1089
Practice Address - Country:US
Practice Address - Phone:857-244-1452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator