Provider Demographics
NPI:1730267980
Name:SAMPLES, CATHRYN L (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:CATHRYN
Middle Name:L
Last Name:SAMPLES
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:LO-306
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-2735
Mailing Address - Fax:617-730-0195
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:LO-306, ADOLESCENT MEDICINE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-7181
Practice Address - Fax:617-730-0195
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA42863208000000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2066629Medicaid
SA E05082Medicare ID - Type Unspecified
MA2066629Medicaid