Provider Demographics
NPI:1407938491
Name:LAMSBACK, E. GARY (MD)
Entity Type:Individual
Prefix:DR
First Name:E.
Middle Name:GARY
Last Name:LAMSBACK
Suffix:
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 1:1650 HUNTINGDON PIKE
Mailing Address - Street 2:SUITE 152
Mailing Address - City:MEADOWBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19046-8004
Mailing Address - Country:US
Mailing Address - Phone:215-947-7005
Mailing Address - Fax:
Practice Address - Street 1:1650 HUNTINGDON PIKE
Practice Address - Street 2:SUITE 152
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8004
Practice Address - Country:US
Practice Address - Phone:215-947-7005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025545E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB41920Medicare UPIN
PA446380Medicare ID - Type Unspecified