1295915684 NPI number — DR. GEORGE RAYMOND ZAMBELLI JR. M.D.

Table of content: WANAKEE WHITE (NPI 1699456947)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295915684 NPI number — DR. GEORGE RAYMOND ZAMBELLI JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZAMBELLI
Provider First Name:
GEORGE
Provider Middle Name:
RAYMOND
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295915684
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
380 ADAMS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15074-2138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-728-5000
Provider Business Mailing Address Fax Number:
724-728-3248

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
380 ADAMS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15074-2138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-728-5000
Provider Business Practice Location Address Fax Number:
724-728-3248
Provider Enumeration Date:
11/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  MD019985E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0010371590003 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 91740 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: E55440 . This is a "UPIN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1503486 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 206043 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 060837 . This is a "PABS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: E55440 . This is a "COVENTRY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5470440 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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