Provider Demographics
NPI:1588840425
Name:ZAMBROTTA, JAIME NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:NICOLE
Last Name:ZAMBROTTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 FIRETHORN CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-2163
Mailing Address - Country:US
Mailing Address - Phone:267-350-7405
Mailing Address - Fax:
Practice Address - Street 1:2601 HOLME AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2007
Practice Address - Country:US
Practice Address - Phone:267-350-7405
Practice Address - Fax:267-350-7496
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT185795207R00000X
PAMD434377207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine