Provider Demographics
NPI:1487875449
Name:RAWLINS, SAMANTHA (PHYSICIAN)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
Last Name:RAWLINS
Suffix:
Gender:F
Credentials:PHYSICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 WICKHAM AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-2232
Mailing Address - Country:US
Mailing Address - Phone:718-239-8383
Mailing Address - Fax:
Practice Address - Street 1:1650 GRAND CONCOURSE
Practice Address - Street 2:5TH FL.OBGYN ADMINISTRATION
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7606
Practice Address - Country:US
Practice Address - Phone:718-239-8383
Practice Address - Fax:718-239-8360
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL119424207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2472342Medicaid
NYI02816Medicare UPIN
NY2472342Medicaid