Basic Information
| Provider Information | |||||||||
| NPI: | 1558352419 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAMOL | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4600 WESLEY AVE | ||||||||
| Address2: | STE. N | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452122298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138415220 | ||||||||
| FaxNumber: | 5138411580 | ||||||||
| Practice Location | |||||||||
| Address1: | 8245 NORTHCREEK DR | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452362283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137451706 | ||||||||
| FaxNumber: | 5138912197 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2005 | ||||||||
| LastUpdateDate: | 02/25/2009 | ||||||||
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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 | 207V00000X | 35083093S | OH | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 7489687 | 01 | OH | AETNA | OTHER | 07-05611 | 01 | OH | UNITED HEALTHCARE | OTHER | 2607950 | 05 | OH | MEDICAID | 299932 | 01 | OH | AMERIGROUP | OTHER | 000000369006 | 01 | OH | ANTHEM | OTHER |