Provider Demographics
NPI:1629024575
Name:SKOBELOFF, EMIL (MD)
Entity Type:Individual
Prefix:DR
First Name:EMIL
Middle Name:
Last Name:SKOBELOFF
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 1:103 BRENT DR
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19086-6610
Mailing Address - Country:US
Mailing Address - Phone:610-874-5565
Mailing Address - Fax:610-874-8672
Practice Address - Street 1:201 REECEVILLE RD
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-1542
Practice Address - Country:US
Practice Address - Phone:610-383-8185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD047678L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001302427Medicaid
PAF15215Medicare UPIN
PA705241Medicare ID - Type Unspecified