Healthcare Provider Details

I. General information

NPI: 1730142977
Provider Name (Legal Business Name): JAN S. ULBRECHT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 12/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 E PARK AVE SUITE 312
STATE COLLEGE PA
16803-6706
US

IV. Provider business mailing address

1850 E PARK AVE SUITE 312
STATE COLLEGE PA
16803-6706
US

V. Phone/Fax

Practice location:
  • Phone: 814-689-3156
  • Fax: 814-689-1954
Mailing address:
  • Phone: 814-689-3156
  • Fax: 814-689-1954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD030063E
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: