Provider Demographics
NPI:1619938529
Name:PETERMAN, AMBROSE B III (DO)
Entity Type:Individual
Prefix:
First Name:AMBROSE
Middle Name:B
Last Name:PETERMAN
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-5677
Mailing Address - Country:US
Mailing Address - Phone:610-327-1785
Mailing Address - Fax:610-327-1414
Practice Address - Street 1:545 E HIGH ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-5677
Practice Address - Country:US
Practice Address - Phone:610-327-1785
Practice Address - Fax:610-327-1414
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004830L207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D75989Medicare UPIN