Provider Demographics
NPI:1922629302
Name:KALTENBACH, SAMANTHA (PA-C)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:KALTENBACH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:DUMBAULD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 746747
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6747
Mailing Address - Country:US
Mailing Address - Phone:666-808-5058
Mailing Address - Fax:374-364-1569
Practice Address - Street 1:131 LEWIS AVE
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1209
Practice Address - Country:US
Practice Address - Phone:614-539-1800
Practice Address - Fax:617-263-3376
Is Sole Proprietor?:No
Enumeration Date:2020-04-27
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.008954RX363A00000X
FL9115222363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant