Provider Demographics
NPI:1093734121
Name:ZAMBOS, PHILIP N (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:N
Last Name:ZAMBOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-0148
Mailing Address - Country:US
Mailing Address - Phone:606-836-4929
Mailing Address - Fax:606-836-3185
Practice Address - Street 1:5000 KY ROUTE 321
Practice Address - Street 2:HIGHLAND REGIONAL MEDICAL CENTER RADIOLOGY DEPT
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-9113
Practice Address - Country:US
Practice Address - Phone:606-836-4929
Practice Address - Fax:606-836-3185
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY258542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65941494Medicaid
7200028000OtherWVA MEDICAID
DC0133OtherRROAD MEDICARE
C68119Medicare UPIN
7200028000OtherWVA MEDICAID