Provider Demographics
NPI:1861457954
Name:SAMBERG, GARY A (DO)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:A
Last Name:SAMBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 FAWN DR
Mailing Address - Street 2:
Mailing Address - City:QUARRYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17566-9741
Mailing Address - Country:US
Mailing Address - Phone:717-284-3137
Mailing Address - Fax:
Practice Address - Street 1:34 FAWN DR
Practice Address - Street 2:
Practice Address - City:QUARRYVILLE
Practice Address - State:PA
Practice Address - Zip Code:17566-9741
Practice Address - Country:US
Practice Address - Phone:717-284-3137
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0S004535L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAD98586Medicare UPIN
PASA42026Medicare ID - Type Unspecified