Provider Demographics
NPI:1275501298
Name:KREB, ROBERT J III (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:KREB
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8701D WEST CHESTER PIKE
Mailing Address - Street 2:C/O CBS
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-1115
Mailing Address - Country:US
Mailing Address - Phone:610-734-0610
Mailing Address - Fax:610-734-0874
Practice Address - Street 1:915 OLD FERN HILL RD
Practice Address - Street 2:STE 4
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4269
Practice Address - Country:US
Practice Address - Phone:610-738-2480
Practice Address - Fax:610-738-2485
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD019161E208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007351490001Medicaid
PA0007351490001Medicaid
C27846Medicare UPIN