Provider Demographics
NPI:1467451476
Name:AMBROSE, JOSEPH E (DO)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:E
Last Name:AMBROSE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CHRISTY PARK DR
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-1584
Mailing Address - Country:US
Mailing Address - Phone:724-349-9430
Mailing Address - Fax:724-349-9431
Practice Address - Street 1:100 CHRISTY PARK DR
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-1584
Practice Address - Country:US
Practice Address - Phone:724-349-9430
Practice Address - Fax:724-349-9431
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-0044831-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAAM462289OtherPA BLUE SHIELD
PA0009281810005Medicaid
C35055Medicare UPIN
PA0009281810005Medicaid