Provider Demographics
NPI:1285867762
Name:KAREN E. AGERSBORG DO ASSOCIATES PC
Entity Type:Organization
Organization Name:KAREN E. AGERSBORG DO ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:AGERSBORG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-280-0692
Mailing Address - Street 1:1900 HAMILTON ST
Mailing Address - Street 2:803
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3889
Mailing Address - Country:US
Mailing Address - Phone:215-248-2600
Mailing Address - Fax:215-248-2606
Practice Address - Street 1:8815 GERMANTOWN AVE
Practice Address - Street 2:SUITE 14
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-2722
Practice Address - Country:US
Practice Address - Phone:215-248-2600
Practice Address - Fax:215-248-2606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010570L207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1629069703OtherNPI, TYPE I