Provider Demographics
NPI:1629069703
Name:AGERSBORG, KAREN E (DO)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:E
Last Name:AGERSBORG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8815 GERMANTOWN AVE
Mailing Address - Street 2:SUITE 14
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-2722
Mailing Address - Country:US
Mailing Address - Phone:215-248-2600
Mailing Address - Fax:215-248-2606
Practice Address - Street 1:8815 GERMANTOWN AVE
Practice Address - Street 2:SUITE 14
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-2722
Practice Address - Country:US
Practice Address - Phone:215-248-2600
Practice Address - Fax:215-248-2606
Is Sole Proprietor?:No
Enumeration Date:2005-10-29
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201612207RE0101X
PAOS010570L207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH60626Medicare UPIN