Provider Demographics
NPI:1568417186
Name:JOSEPH E AMBROSE DO
Entity Type:Organization
Organization Name:JOSEPH E AMBROSE DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:AMBROSE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:724-349-9430
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 1:875 HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3662
Practice Address - Country:US
Practice Address - Phone:724-463-9700
Practice Address - Fax:724-463-9702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05004831L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAAM462289OtherPA BLUE SHIELD
PA0009281810005Medicaid
PA0009281810005Medicaid
C35055Medicare UPIN