Provider Demographics
NPI:1619917267
Name:NAGELBERG, STEVEN BROOKS (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:BROOKS
Last Name:NAGELBERG
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 1:9501 ROOSEVELT BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1025
Mailing Address - Country:US
Mailing Address - Phone:215-969-9511
Mailing Address - Fax:215-969-9512
Practice Address - Street 1:9501 ROOSEVELT BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1025
Practice Address - Country:US
Practice Address - Phone:215-969-9511
Practice Address - Fax:215-969-9512
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033710E207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA061644OtherBLUE SHIELD
PA061644EZ5Medicare PIN
PA061644OtherBLUE SHIELD