Provider Demographics
NPI:1124265004
Name:UFBERG, PAUL JACOB (DO, MBA)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JACOB
Last Name:UFBERG
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Gender:M
Credentials:DO, MBA
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Mailing Address - Street 1:100 E PENN SQ
Mailing Address - Street 2:9TH FL NORTH TOWER
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3323
Mailing Address - Country:US
Mailing Address - Phone:267-425-9232
Mailing Address - Fax:267-425-9299
Practice Address - Street 1:3401 CIVIC CENTER BLVD
Practice Address - Street 2:CHILDRENS HOSPITAL OF PHILADELPHIA CHCA GASTRO
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4319
Practice Address - Country:US
Practice Address - Phone:215-590-3247
Practice Address - Fax:215-590-3606
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2015-11-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS0139802080P0206X
AZ0052012080P0206X
MEDO23272080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME003109102Medicare PIN
ME003109101Medicare PIN
AZZ146251Medicare PIN