Provider Demographics
NPI:1013915743
Name:BOBECK, HENRY S (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:S
Last Name:BOBECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:610 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-3702
Mailing Address - Country:US
Mailing Address - Phone:570-288-5441
Mailing Address - Fax:570-288-5842
Practice Address - Street 1:892 MAIN ST
Practice Address - Street 2:
Practice Address - City:SUGAR NOTCH
Practice Address - State:PA
Practice Address - Zip Code:18706-2015
Practice Address - Country:US
Practice Address - Phone:570-822-6916
Practice Address - Fax:570-824-6936
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036890E175L00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No175L00000XOther Service ProvidersHomeopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010621420001Medicaid
PAB41849Medicare UPIN
PA0010621420001Medicaid