Provider Demographics
NPI:1245550151
Name:DAVID P. ZAMBO, D.O., LLC
Entity type:Organization
Organization Name:DAVID P. ZAMBO, D.O., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:ZAMBO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-759-5501
Mailing Address - Street 1:4263 LONATE DR
Mailing Address - Street 2:
Mailing Address - City:NAZARETH
Mailing Address - State:PA
Mailing Address - Zip Code:18064-8403
Mailing Address - Country:US
Mailing Address - Phone:610-759-5501
Mailing Address - Fax:610-759-2216
Practice Address - Street 1:4263 LONATE DR
Practice Address - Street 2:
Practice Address - City:NAZARETH
Practice Address - State:PA
Practice Address - Zip Code:18064-8403
Practice Address - Country:US
Practice Address - Phone:610-759-5501
Practice Address - Fax:610-759-2216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010281L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0202788000OtherINDEPENDENCE BLUE CROSS
PA008429OtherBLUE SHIELD
PA01789046Medicaid
PA01022401OtherCAPITAL BLUE CROSS
PA0202788000OtherINDEPENDENCE BLUE CROSS
PA01789046Medicaid