Provider Demographics
NPI:1487214912
Name:HARMON, SAM KISTLER
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:KISTLER
Last Name:HARMON
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 1:189 EXETER RD
Mailing Address - Street 2:
Mailing Address - City:NEWFIELDS
Mailing Address - State:NH
Mailing Address - Zip Code:03856-8225
Mailing Address - Country:US
Mailing Address - Phone:760-625-5634
Mailing Address - Fax:
Practice Address - Street 1:189 EXETER RD
Practice Address - Street 2:
Practice Address - City:NEWFIELDS
Practice Address - State:NH
Practice Address - Zip Code:03856-8225
Practice Address - Country:US
Practice Address - Phone:760-625-5634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman