Provider Demographics
NPI:1851397731
Name:JOSEPH F. MAMBU, MD PC
Entity Type:Organization
Organization Name:JOSEPH F. MAMBU, MD PC
Other - Org Name:FAMILY MEDICINE, GERIATRICS & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:F
Authorized Official - Last Name:MAMBU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-540-4411
Mailing Address - Street 1:714 N BETHLEHEM PIKE
Mailing Address - Street 2:STE 101
Mailing Address - City:LOWER GWYNEDD
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2655
Mailing Address - Country:US
Mailing Address - Phone:215-540-4411
Mailing Address - Fax:215-540-4415
Practice Address - Street 1:714 N BETHLEHEM PIKE
Practice Address - Street 2:STE 101
Practice Address - City:LOWER GWYNEDD
Practice Address - State:PA
Practice Address - Zip Code:19002-2655
Practice Address - Country:US
Practice Address - Phone:215-540-4411
Practice Address - Fax:215-540-4415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017725E207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0864515001OtherBCBS-PA KEYSTONE
PA921651OtherBCBS-PA HIGHMARK
PA0864515001OtherBCBS-PA KEYSTONE