Healthcare Provider Details

I. General information

NPI: 1013125582
Provider Name (Legal Business Name): ROGER LOUIS CAMBOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 PROVIDENCE AVE
CHESTER PA
19013-5504
US

IV. Provider business mailing address

206 STEPNEY PL
NARBERTH PA
19072-1610
US

V. Phone/Fax

Practice location:
  • Phone: 610-876-9000
  • Fax: 484-490-0116
Mailing address:
  • Phone: 720-470-3802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number40248
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number40428
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: