Provider Demographics
NPI:1538164074
Name:AMBROSE, JASON R (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:R
Last Name:AMBROSE
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 1:1612 LEVEL STREAM RD
Mailing Address - Street 2:
Mailing Address - City:WENDELL
Mailing Address - State:NC
Mailing Address - Zip Code:27591-3361
Mailing Address - Country:US
Mailing Address - Phone:252-347-4915
Mailing Address - Fax:
Practice Address - Street 1:1612 LEVEL STREAM RD
Practice Address - Street 2:
Practice Address - City:WENDELL
Practice Address - State:NC
Practice Address - Zip Code:27591-3361
Practice Address - Country:US
Practice Address - Phone:252-347-4915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2025-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300115207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13306OtherBCBS NC
NC8913306Medicaid
NCP00013099OtherRAILROAD MEDICARE
NC2013615Medicare PIN
NCP00013099OtherRAILROAD MEDICARE