MEDICARE: MR. JOSEPH E. AMBROSE D.O.

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	207R00000X	Internal Medicine Physician	OS-0044831-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AM462289	OTHER	PA	PA BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467451476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH E. AMBROSE D.O.

Provider Business Mailing Address
First Line	:	100 CHRISTY PARK DR
Second Line	:
City	:	INDIANA
State	:	PA
Zip	:	15701-1584
Country	:	US
Telephone Number	:	724-349-9430
Fax Number	:	724-349-9431

Provider Business Practice Location Address
First Line	:	100 CHRISTY PARK DR
Second Line	:
City	:	INDIANA
State	:	PA
Zip	:	15701-1584
Country	:	US
Telephone Number	:	724-349-9430
Fax Number	:	724-349-9431

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	10/01/2019

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