Provider Demographics
NPI:1588610877
Name:BAMBERGER, PETER KURT (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:KURT
Last Name:BAMBERGER
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 1:301 S 7TH AVE
Mailing Address - Street 2:SUITE 315
Mailing Address - City:WEST READING
Mailing Address - State:PA
Mailing Address - Zip Code:19611-1410
Mailing Address - Country:US
Mailing Address - Phone:610-374-7720
Mailing Address - Fax:610-374-8520
Practice Address - Street 1:301 S 7TH AVE
Practice Address - Street 2:SUITE 315
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1410
Practice Address - Country:US
Practice Address - Phone:610-374-7720
Practice Address - Fax:610-374-8520
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070577L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA017930580001Medicaid
PA017930580001Medicaid
PABA036352Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID