Healthcare Provider Details

I. General information

NPI: 1467454447
Provider Name (Legal Business Name): H. BRENT BAMBERGER D. O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 12/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 LITTLE YORK RD STE. 10
DAYTON OH
45414-5800
US

IV. Provider business mailing address

PO BOX 713130
CINCINNATI OH
45271-0001
US

V. Phone/Fax

Practice location:
  • Phone: 937-415-9100
  • Fax: 937-415-9191
Mailing address:
  • Phone: 937-415-9100
  • Fax: 937-415-9191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number4370
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: