Provider Demographics
NPI:1851705180
Name:GOMBAR, YULIYA (DO)
Entity Type:Individual
Prefix:DR
First Name:YULIYA
Middle Name:
Last Name:GOMBAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:GOMBAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:301 E CITY AVE
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1708
Mailing Address - Country:US
Mailing Address - Phone:610-617-1300
Mailing Address - Fax:
Practice Address - Street 1:301 E CITY AVE STE 100
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1738
Practice Address - Country:US
Practice Address - Phone:610-771-0260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-14
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT015998207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine