Provider Demographics
NPI:1548256472
Name:SAMPSON, MITZI JEAN (MD)
Entity type:Individual
Prefix:DR
First Name:MITZI
Middle Name:JEAN
Last Name:SAMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 PARK HILL DR STE B
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3361
Mailing Address - Country:US
Mailing Address - Phone:540-370-4370
Mailing Address - Fax:549-370-4331
Practice Address - Street 1:211 PARK HILL DR STE B
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3361
Practice Address - Country:US
Practice Address - Phone:540-370-4370
Practice Address - Fax:540-370-4331
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047353207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1669794921OtherNPI CORPORATE
VA1669794921OtherNPI CORPORATE