Basic Information
| Provider Information | |||||||||
| NPI: | 1457388621 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAMPSON | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1572 | ||||||||
| Address2: | |||||||||
| City: | RADFORD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 241431572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406396736 | ||||||||
| FaxNumber: | 5406331524 | ||||||||
| Practice Location | |||||||||
| Address1: | 817 DAVIS ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | BLACKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240607013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405521205 | ||||||||
| FaxNumber: | 5409510633 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | 0102201454 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0102201454 | 01 | VA | STATE LIC. NUMBER | OTHER |