Basic Information
Provider Information | |||||||||
NPI: | 1447258561 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SAMALE | ||||||||
FirstName: | GIRO | ||||||||
MiddleName: | RICHARD | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SAMALE | ||||||||
OtherFirstName: | RICHARD | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | PROF. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | P.O. BOX 30 | ||||||||
Address2: |   | ||||||||
City: | GREAT BARRINGTON | ||||||||
State: | MA | ||||||||
PostalCode: | 01230 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4135289311 | ||||||||
FaxNumber: | 4136440274 | ||||||||
Practice Location | |||||||||
Address1: | 510 NORTH STREET | ||||||||
Address2: |   | ||||||||
City: | PITTSFIELD | ||||||||
State: | MA | ||||||||
PostalCode: | 01201 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4134472351 | ||||||||
FaxNumber: | 4134457009 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/12/2005 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME48291 | FL | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | 150401 | MA | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 45193 | 01 | FL | BC/BS GROUP # | OTHER | 866091 | 01 | FL | UNITED HEALTH CARE # | OTHER | 2372318001 | 01 | FL | CIGNA | OTHER | 372213900 | 05 | FL |   | MEDICAID |