Provider Demographics
NPI:1952374480
Name:R. D. JAMBRO, M.D., P.C.
Entity Type:Organization
Organization Name:R. D. JAMBRO, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:JAMBRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-752-4848
Mailing Address - Street 1:172 MIDDLETOWN BLVD STE 203
Mailing Address - Street 2:POST OFFICE BOX L-#305
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1871
Mailing Address - Country:US
Mailing Address - Phone:215-752-4848
Mailing Address - Fax:215-741-1498
Practice Address - Street 1:172 MIDDLETOWN BLVD
Practice Address - Street 2:SUITE #203
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1871
Practice Address - Country:US
Practice Address - Phone:215-752-4848
Practice Address - Fax:215-741-1498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-014022E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0000593242Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER