SAMUEL GRAY DEEM


Address: 3100 Maccorkle Ave Se, Suite 602, Charleston, WV 25304-1223
Phone: 3043885120

SAMUEL GRAY DEEM (NPI# 1700909702) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1700909702
Entity Type Individual
Full Name SAMUEL GRAY DEEM
Credential DO
Practice Address 3100 Maccorkle Ave Se
Suite 602
Charleston
WV 25304-1223
Mailing Address 3100 Maccorkle Ave Se Ste 602
Charleston
WV 25304
Practice Telephone 3043885120
Practice Fax Number 3043885125
Mailing Telephone 3043885280
Mailing Fax Number 3043885291
Enumeration Date 2007-04-06
Last Update Date 2015-12-14
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 208800000X Urology 2176 WV Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
WV 3810010649 05
WV RAILROAD MEDICARE P01087428 01

Office Location

Street Address 3100 MACCORKLE AVE SE
SUITE 602
City CHARLESTON
State WV
Zip Code 25304-1223

Providers in the same location

NPI Name Taxonomy Address Enumeration
1053312314 Kurt M. Nellhaus, M.d. Internal Medicine 3100 Maccorkle Ave Se, Suite 806, Charleston, WV 25304-1223 2005-08-09
1124575907 Cmc Pharmacy, LLC Pharmacy 3100 Maccorkle Ave Se, Suite 100, Charleston, WV 25304-1223 2016-09-08
1386191575 William F. Brogan Nurse Practitioner 3100 Maccorkle Ave Se, Suite 301, Charleston, WV 25304-1223 2016-09-06
1083161475 Amanda L. Newcomer Nurse Practitioner 3100 Maccorkle Ave Se, Suite 301, Charleston, WV 25304-1223 2016-09-02
1437508868 Brandon Waskey Nurse Practitioner 3100 Maccorkle Ave Se, Suite 700, Charleston, WV 25304-1223 2016-06-07
1992177984 Sandra Henline Physician Assistant 3100 Maccorkle Ave Se, Suite 411, Charleston, WV 25304-1223 2015-10-29
1598157430 Wv Heart and Vascular Institute Charleston Internal Medicine 3100 Maccorkle Ave Se, Suite 610, Charleston, WV 25304-1223 2015-03-02
1922403435 Chad L. Miller Physician Assistant 3100 Maccorkle Ave Se, Suite 101, Charleston, WV 25304-1223 2014-10-27
1114321809 Jennifer J. Hancock Psychologist 3100 Maccorkle Ave Se, Suite 101, Charleston, WV 25304-1223 2014-10-09
1720487267 Deborah Rectenwald Nurse Practitioner 3100 Maccorkle Ave Se, Suite 406, Charleston, WV 25304-1223 2014-08-21
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1740893908 Sade Yvonne Rice Technician 392 B South Parkd Rd, Charleston, WV 25304 2020-08-27
1053931410 Pir Ali Shah Student in an Organized Health Care Education/Training Program 3200 Maccorkle Avenue Southeast Robert C. Bind Clinical, Charleston, WV 25304 2020-04-25
1649807603 Jasmine Shah Student in an Organized Health Care Education/Training Program 3110 Maccorkle Avenue, Se, Student Services Department - Wvu Building, 4th Floor, Charleston, WV 25304 2020-03-26
1447811872 Kwasi Amponsah Gambrah Student in an Organized Health Care Education/Training Program 3200 Mac Corkle Ave. Se, Robert C. Byrd Clinical Teaching Center, 5th Floor, Charlestoni, WV 25304 2019-06-26
1457916751 Divya Kalluru Student in an Organized Health Care Education/Training Program 3200 Maccorkle Avenue Southeast, Robert C. Bird Clinica, 4th Floor Internal Medicine Department, Charleston, WV 25304 2019-05-02
1841854965 Sean Michael Percy Losier Student in an Organized Health Care Education/Training Program 3200 Maccorkle Ave., Se, Camc Family Medicine Center Robert C. Byrd Clinical Tea, Charleston, WV 25304 2019-04-24
1700440047 Priyanka Chowdhry Student in an Organized Health Care Education/Training Program Robert C. Bird Clinical Training Center, 4th Floor, 3200 Maccorkle Avenue, Southeast, Charleston, WV 25304 2019-04-23
1568925469 Saranya Dinesan Student in an Organized Health Care Education/Training Program 3200 Maccorkle Ave. Se, 4th Floor, Robert C. Byrd Clini, Charleston, WV 25304 2019-04-09
1043771694 Mary Elizabeth Novak Student in an Organized Health Care Education/Training Program Camc Memorial Hospital, Surgicare Center, 3200 Maccorkle Ave Se, Charleston, WV 25304 2019-03-27
1124518600 Abdullah Sohail Student in an Organized Health Care Education/Training Program 4th Floor, 3200 Maccorkle Ave, South East Robert C. Bir, Charleston, WV 25304 2018-05-10
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Taxonomy Information

Taxonomy Code 208800000X
Grouping Allopathic & Osteopathic Physicians
Classification Urology

Taxonomy Definition

A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1295393098 Christopher William Ritchie Urology 135 Rutledge Ave Fl 5, Charleston, SC 29425-8903 2019-06-05
1326487588 Tracy Jon Tipton Urology 125 Doughty St Ste 300, Charleston, SC 29403 2013-06-21
1679828750 Thomas Alexander Kirkland Jr. Urology 2 Ladson St, Apt. A, Charleston, SC 29401-2757 2012-07-16
1174846398 Paul Walter Sanders Urology 18 Guerard Rd, Charleston, SC 29407-7549 2010-03-02
1093948283 Samuel Dwane Thomas Urology 2 Wharfside St Apt 5e, Charleston, SC 29401-1653 2009-09-03
1649496571 Shozo Kurusu Urology 1313 Quarrier St, Charleston, WV 25301-6002 2007-04-18
1588722102 Bashir R. Sankari Urology 501 Morris Street, 5 West, Camc Renal Transplant Center, Charleston, WV 25301 2006-12-05
1053497453 Ross Samuel Oliver Jr. Urology 2335 Chesterfield Avenue, Suite 101, Charleston, WV 25304-1066 2006-10-27
1205920261 James P. Tierney Urology 11 Courtney Drive, Charleston, WV 25304 2006-10-03
1861400632 Integrated Health Care Providers, Inc. Urology 1201 Washington St E Ste 105, Charleston, WV 25301-1850 2006-08-04
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City CHARLESTON
Zip Code 25304

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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