Healthcare Provider Details

I. General information

NPI: 1558609065
Provider Name (Legal Business Name): JAMES LAWRENCE EPPELBAUM D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2013
Last Update Date: 06/10/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MAIN ST
SAEGERTOWN PA
16433-0846
US

IV. Provider business mailing address

1034 GROVE ST
MEADVILLE PA
16335-2945
US

V. Phone/Fax

Practice location:
  • Phone: 147-631-1068
  • Fax: 814-763-1129
Mailing address:
  • Phone: 814-373-3530
  • Fax: 814-333-1757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS017230
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: