Provider Demographics
NPI:1316992225
Name:P. KURT BAMBERGER, M.D., P.C.
Entity type:Organization
Organization Name:P. KURT BAMBERGER, M.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:KURT
Authorized Official - Last Name:BAMBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-374-7720
Mailing Address - Street 1:301 S 7TH AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:WEST READING
Mailing Address - State:PA
Mailing Address - Zip Code:19611-1410
Mailing Address - Country:US
Mailing Address - Phone:610-374-7720
Mailing Address - Fax:610-374-8520
Practice Address - Street 1:301 S 7TH AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1410
Practice Address - Country:US
Practice Address - Phone:610-374-7720
Practice Address - Fax:610-374-8520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070577L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018881600001Medicaid
PA0018881600001Medicaid