Healthcare Provider Details

I. General information

NPI: 1174503791
Provider Name (Legal Business Name): ALLEN A DZAMBO JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 JEFFERSON ST
LATROBE PA
15650-1915
US

IV. Provider business mailing address

1200 JEFFERSON ST
LATROBE PA
15650-1915
US

V. Phone/Fax

Practice location:
  • Phone: 724-539-3444
  • Fax: 724-539-4133
Mailing address:
  • Phone: 724-539-3444
  • Fax: 724-539-4133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC004642L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: