Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | MD022445E | PA |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | MD022445E | PA |
NPI | 1215991385 |
---|---|
Provider Name | Anthony Ambrose |
First Address | Hershey, PA 17033-0858 |
Second Address | Hershey, PA 17033-2086 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 16/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0014226210005 | (05) | PA |
E25342 | (02) |