| Doctor Name: | DR. SAMUEL JOHN VASELICH |
| NPI Number: | 1639348014 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DO |
| License Number: | SL0535 |
| Business Practice Address: | 2602 Isaac Dr Goldsboro, NC - 275308117 |
| Business Phone Number: | 7039658088 |
| Business Fax Number: | |
| Mailing Address: | 2602 Isaac Dr, GOLDSBORO |
| State: | NC |
| Postal Code: | 275308117 |
| Phone Number: | 7039658088 |
| Fax Number: | |
| NPI Enumeration Date: | 02/29/2008 |
| NPI Last Update Date: | 06/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | SL0535 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NV |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |