Basic Information
| Provider Information | |||||||||
| NPI: | 1780655506 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAMPSON | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2014 WASHINGTON STREET | ||||||||
| Address2: | |||||||||
| City: | NEWTON LOWER FALLS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024621607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172436135 | ||||||||
| FaxNumber: | 6172435809 | ||||||||
| Practice Location | |||||||||
| Address1: | 2014 WASHINGTON STREET | ||||||||
| Address2: | |||||||||
| City: | NEWTON LOWER FALLS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024621607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172436135 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2006 | ||||||||
| LastUpdateDate: | 10/05/2007 | ||||||||
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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 | 207ZP0102X | 33006 | MA | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | B33373 | 01 | MA | BLUE CROSS | OTHER | 6179746 | 05 | MA | MEDICAID |