Provider Demographics
NPI:1154356459
Name:AMBANI, NARENDRA V (MD)
Entity type:Individual
Prefix:
First Name:NARENDRA
Middle Name:V
Last Name:AMBANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 BLAKESLEE BLVD EAST
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-8753
Mailing Address - Country:US
Mailing Address - Phone:610-377-3252
Mailing Address - Fax:610-826-1289
Practice Address - Street 1:990 BLAKESLEE BLVD EAST
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-8753
Practice Address - Country:US
Practice Address - Phone:610-377-3252
Practice Address - Fax:610-826-1289
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022000E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006116420001Medicaid
PA0006116420001Medicaid