Provider Demographics
NPI:1932107893
Name:LAMBO, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:LAMBO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020A E BOAL AVE
Mailing Address - Street 2:
Mailing Address - City:BOALSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16827-1509
Mailing Address - Country:US
Mailing Address - Phone:814-237-8627
Mailing Address - Fax:814-238-0083
Practice Address - Street 1:1611 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-3241
Practice Address - Country:US
Practice Address - Phone:610-327-7301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD048359L2085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA03208801OtherCAPITAL ADVANTAGE
PA1708367003OtherCIGNA
PA0014105310001Medicaid
PA745006OtherINTER COUNTY HEALTH PLAN
PA745006OtherPA BCBS
PA2042451OtherUSHC
PA654170000OtherAMERIHEALTH
PA20022955OtherAMERIHEALTH MERCY
PA000000134289OtherTHREE RIVERS/MEDPLUS
PA0654170000OtherHEYSTONE HEALTH PLAN
PA1031959OtherKEYSTONE MERCY
PA745006PW8Medicare ID - Type Unspecified
PA654170000OtherAMERIHEALTH
PA0014105310001Medicaid