Provider Demographics
NPI:1366091969
Name:SAMPSON, CONNOR ROLLAND
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:ROLLAND
Last Name:SAMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 SHEA ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-4854
Mailing Address - Country:US
Mailing Address - Phone:508-395-1890
Mailing Address - Fax:
Practice Address - Street 1:375 CHURCH ST
Practice Address - Street 2:
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247-4124
Practice Address - Country:US
Practice Address - Phone:413-662-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program