MEDICARE: WILLIAM R. PREBOLA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	MD042746L	PA
2	208100000X	Physical Medicine & Rehabilitation Physician	MD042746L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	P00120684	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	534521	OTHER	PA	AETNA
2	635251	OTHER	PA	BLUE CARE
3	25-1645055	OTHER	PA	UNITEDHEALTH CARE
4	50075038	OTHER	PA	CAPITAL BLUE CROSS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	20007268	OTHER	PA	AMERIHEALTH
7	800082	OTHER	PA	BLUE CARE HMO (FPH)
8	14674-1067	OTHER	PA	GEISINGER

General Provider Information

NPI Number	:	1447243902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM R. PREBOLA M.D.

Provider Business Mailing Address
First Line	:	150 MUNDY ST
Second Line	:	MAC IV BUILDING
City	:	WILKES BARRE
State	:	PA
Zip	:	18702-6830
Country	:	US
Telephone Number	:	570-824-0930
Fax Number	:	570-824-7755

Provider Business Practice Location Address
First Line	:	150 MUNDY ST
Second Line	:
City	:	WILKES BARRE
State	:	PA
Zip	:	18702-6830
Country	:	US
Telephone Number	:	570-824-0930
Fax Number	:	570-824-7755

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	03/20/2015

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Directions to “ WILLIAM R. PREBOLA M.D.” Practice Location

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