Healthcare Provider Details

I. General information

NPI: 1174579114
Provider Name (Legal Business Name): AMBLER PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 S BETHLEHEM PIKE SUITE D
AMBLER PA
19002-5800
US

IV. Provider business mailing address

602 S BETHLEHEM PIKE SUITE D
AMBLER PA
19002-5800
US

V. Phone/Fax

Practice location:
  • Phone: 215-643-7771
  • Fax: 215-643-9463
Mailing address:
  • Phone: 215-643-7771
  • Fax: 215-643-9463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1025833
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: DR. FREDRIC T SEROTA
Title or Position: PRESIDENT
Credential: M.D., J.D.
Phone: 215-643-7771