Provider Demographics
NPI:1518051036
Name:SOBOTA, BRET T (MD)
Entity Type:Individual
Prefix:DR
First Name:BRET
Middle Name:T
Last Name:SOBOTA
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 1:500 UNIVERSITY DR MC CA410
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2360
Mailing Address - Country:US
Mailing Address - Phone:717-531-5208
Mailing Address - Fax:717-531-0119
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2360
Practice Address - Country:US
Practice Address - Phone:717-531-6822
Practice Address - Fax:717-531-4907
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD062010L207Y00000X, 207YP0228X, 207YX0007X, 207YX0901X, 207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA560617OtherHEALTH AMERICA
PA867633OtherMEDICARE GROUP #
PA25-1716306OtherMULTIPLAN/PHCS
PA7064055OtherAETNA NON-HMO
PA1018454060001Medicaid
PA1367953OtherHIGHMARK BLUESHIELD
PA25-1716306OtherINTERGROUP
PA25-1716306OtherFIRST HEALTH
PAG920-0054OtherCAREFIRST
PA2163302OtherMAMSI
PA25-1716306OtherGREATWEST HEALTHCARE
PAP00411722OtherRAILROAD MEDICARE
PA25-1716306OtherDEVON
PA25-1716306OtherHEALTHNET/TRICARE
PA1007307260034OtherMEDICAID GROUP #
PA120420405OtherDEPT OF LABOR
PAMD062010LOtherPA LICENSE
PA1547181OtherGATEWAY
PA25-1716306OtherINFORMED
PA25-1716306OtherSOUTH CENTRAL PREFERRED
PA3830436OtherAETNA HMO
PA50066685OtherCAPITAL BLUECROSS
PAMD062010LOtherPA LICENSE
PA1547181OtherGATEWAY
PA7064055OtherAETNA NON-HMO