Provider Demographics
NPI:1114956612
Name:AMBROSE, RACHELLE LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:RACHELLE
Middle Name:LYNN
Last Name:AMBROSE
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 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-812-4240
Mailing Address - Fax:717-848-5520
Practice Address - Street 1:2050 S QUEEN ST
Practice Address - Street 2:STE 100
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4829
Practice Address - Country:US
Practice Address - Phone:717-812-4240
Practice Address - Fax:717-848-5520
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418846208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA20016261OtherAMERIHEALTH MERCY-WMG CRD
PA001886774Medicaid
PA7909460OtherAETNA
PA100433OtherGEISINGER
PA20015715OtherAMERIHEALTH MERCY-WMG QST
PA281434OtherMAMSI-WMG
PA03163601OtherCAPITAL BLUE CROSS-WMG
PA1392227OtherHIGHMARK BLUE SHIELD
PAP004690OtherGATEWAY-WMG
PA104591OtherJOHNS HOPKINS
PA129798OtherUNISON-WMG
PA129798OtherUNISON-WMG
PA7909460OtherAETNA
PA03163601OtherCAPITAL BLUE CROSS-WMG
PA001886774Medicaid