Basic Information
Provider Information
NPI: 1073719076
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AKACH
FirstName: SAMIR
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 100 N ACADEMY AVE
Address2:  
City: DANVILLE
State: PA
PostalCode: 178224903
CountryCode: US
TelephoneNumber: 5702716144
FaxNumber: 5702716578
Practice Location
Address1: 1000 E MOUNTAIN BLVD
Address2:  
City: WILKES BARRE
State: PA
PostalCode: 187110027
CountryCode: US
TelephoneNumber: 5708087300
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/26/2007
LastUpdateDate: 08/21/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/21/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMD432027PAN Allopathic & Osteopathic PhysiciansInternal Medicine 
208M00000XMD432027PAY Allopathic & Osteopathic PhysiciansHospitalist 

No ID Information.


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