Provider Demographics
NPI:1598453508
Name:MAMBULU, FAUSTIN KALAMBAY (MBBS)
Entity Type:Individual
Prefix:
First Name:FAUSTIN
Middle Name:KALAMBAY
Last Name:MAMBULU
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822
Mailing Address - Country:US
Mailing Address - Phone:570-214-5349
Mailing Address - Fax:570-808-5967
Practice Address - Street 1:GEISINGER WYOMING VALLEY MEDICAL CENTER
Practice Address - Street 2:1000 E MOUNTAIN DRIVE
Practice Address - City:WILKES-BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711
Practice Address - Country:US
Practice Address - Phone:570-808-3746
Practice Address - Fax:570-808-5967
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program