Provider Demographics
NPI:1851736631
Name:GAMBOGI, ELIZABETH KABERLE (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KABERLE
Last Name:GAMBOGI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:KABERLE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER BLVD
Mailing Address - Street 2:DEPARTMENT OF MEDICINE 3 EAST
Mailing Address - City:CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19013-3902
Mailing Address - Country:US
Mailing Address - Phone:610-874-6114
Mailing Address - Fax:
Practice Address - Street 1:33 SOUTH 9TH STREET
Practice Address - Street 2:SUITE 740
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4409
Practice Address - Country:US
Practice Address - Phone:215-955-6680
Practice Address - Fax:215-503-3333
Is Sole Proprietor?:No
Enumeration Date:2013-05-07
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT203498390200000X
PAMD461216207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032933390002Medicaid