Provider Demographics
NPI:1174737878
Name:SAMERSON, MARIA ELENA (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ELENA
Last Name:SAMERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 82969
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33682-2969
Mailing Address - Country:US
Mailing Address - Phone:813-866-0930
Mailing Address - Fax:813-866-0929
Practice Address - Street 1:3901 S WESTSHORE BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-1003
Practice Address - Country:US
Practice Address - Phone:813-712-1940
Practice Address - Fax:813-866-0929
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088817208000000X
FLME104221208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001165400Medicaid