Provider Demographics
NPI:1164536405
Name:EPHRATA RADIOLOGIC ASSOCIATES LTD
Entity Type:Organization
Organization Name:EPHRATA RADIOLOGIC ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROSBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-738-6137
Mailing Address - Street 1:2 MERIDIAN BLVD
Mailing Address - Street 2:2ND FLR
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3202
Mailing Address - Country:US
Mailing Address - Phone:610-372-4957
Mailing Address - Fax:610-288-0173
Practice Address - Street 1:169 MARTIN AVE
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1724
Practice Address - Country:US
Practice Address - Phone:717-738-6137
Practice Address - Fax:717-859-4475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009042050010Medicaid
PA0009042050010Medicaid