Provider Demographics
NPI:1497723936
Name:AMBROSE, DAVID NOBLE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:NOBLE
Last Name:AMBROSE
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 1:1201 GRAMPIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1205 GRAMPIAN BLVD
Practice Address - Street 2:SUITE 1A
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-1978
Practice Address - Country:US
Practice Address - Phone:570-320-7800
Practice Address - Fax:570-320-7801
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021011E207VX0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007123960004Medicaid
PA479946OtherUNITEDHEALTHCARE
PAB30688OtherHEALTHAMERICA
PA006364OtherHIGHMARK BLUE SHIELD
PA440004OtherFIRST PRIORITY HEALTH
PA0007123960005Medicaid
PA002147OtherFIRST PRIORITY HEALTH
PA479946OtherUNITEDHEALTHCARE
PA0007123960004Medicaid
PA080143233Medicare PIN