Provider Demographics
NPI:1982225629
Name:DE GANNES, SAMANTHA (MD)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
Last Name:DE GANNES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STRETSON BUILDING 260 STETSON STREET SUITE 2300
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45267-0525
Mailing Address - Country:US
Mailing Address - Phone:513-558-7964
Mailing Address - Fax:513-558-4305
Practice Address - Street 1:STRETSON BUILDING 260 STETSON STREET SUITE 2300
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45267-0525
Practice Address - Country:US
Practice Address - Phone:513-558-7964
Practice Address - Fax:513-558-4305
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP100725892084N0400X
OH35.1509952084E0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084E0001XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyEpilepsy
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology