Provider Demographics
NPI:1174503791
Name:DZAMBO, ALLEN A JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:A
Last Name:DZAMBO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-1915
Mailing Address - Country:US
Mailing Address - Phone:724-539-3444
Mailing Address - Fax:724-539-4133
Practice Address - Street 1:1200 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1915
Practice Address - Country:US
Practice Address - Phone:724-539-3444
Practice Address - Fax:724-539-4133
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004642L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017663730004Medicaid
PA001799222OtherBLUE SHIELD
PA0017663730003Medicaid
PA0017663730004Medicaid
PA5905140001Medicare NSC
PA001799222OtherBLUE SHIELD