MEDICARE: CARLOS SAN PEDRO MADAMBA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	25MA05508600	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811994866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS SAN PEDRO MADAMBA MD

Provider Business Mailing Address
First Line	:	51 N 39TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-2640
Country	:	US
Telephone Number	:	856-906-6273
Fax Number	:

Provider Business Practice Location Address
First Line	:	51 N 39TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-2640
Country	:	US
Telephone Number	:	856-906-6273
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	09/07/2016

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