Provider Demographics
NPI:1447251913
Name:SAMSON, RICHARD T E (DPM)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:T E
Last Name:SAMSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 FIRST PARK DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:OAKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04963-5361
Mailing Address - Country:US
Mailing Address - Phone:207-872-6010
Mailing Address - Fax:207-872-4566
Practice Address - Street 1:25 FIRST PARK DR
Practice Address - Street 2:SUITE C
Practice Address - City:OAKLAND
Practice Address - State:ME
Practice Address - Zip Code:04963-5361
Practice Address - Country:US
Practice Address - Phone:207-872-6010
Practice Address - Fax:207-872-4566
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD1010213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME133050000Medicaid
MEE400177042Medicare Oscar/Certification
MEU63990Medicare UPIN