Provider Demographics
NPI:1558325399
Name:AMBROSE, JOSEPH PATRICK (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PATRICK
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 1:61 TALSMAN DR
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-1207
Mailing Address - Country:US
Mailing Address - Phone:330-533-2218
Mailing Address - Fax:330-533-6111
Practice Address - Street 1:61 TALSMAN DR
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-1207
Practice Address - Country:US
Practice Address - Phone:330-533-2218
Practice Address - Fax:330-533-6111
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-2786-A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0394952Medicaid
OH0394952Medicaid