Provider Demographics
NPI:1538621636
Name:FAUGHT, SAMUEL D
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:D
Last Name:FAUGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 S 9TH ST STE 210
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-6810
Mailing Address - Country:US
Mailing Address - Phone:215-955-8430
Mailing Address - Fax:215-923-7885
Practice Address - Street 1:211 S 9TH ST STE 600
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-6810
Practice Address - Country:US
Practice Address - Phone:215-955-8430
Practice Address - Fax:215-923-5828
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2024-0495207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology