Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | MD451862 | PA |
N | 2084N0400X | Neurologist | MT197867 | PA |
NPI | 1013237981 |
---|---|
Provider Name | Dr. Timothy Michael Ambrose |
First Address | Philadelphia, PA 19107-5211 |
Second Address | Philadelphia, PA 19107-5211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2010 |
Last Update Date | 23/06/2016 |