Basic Information
| Provider Information | |||||||||
| NPI: | 1235171604 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMBROSE B PETERMAN III DO FAMILY MEDICINE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 545 E HIGH ST | ||||||||
| Address2: | |||||||||
| City: | POTTSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194645677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103271785 | ||||||||
| FaxNumber: | 6103271414 | ||||||||
| Practice Location | |||||||||
| Address1: | 545 E HIGH ST | ||||||||
| Address2: | |||||||||
| City: | POTTSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194645677 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103271785 | ||||||||
| FaxNumber: | 6103271414 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2006 | ||||||||
| LastUpdateDate: | 06/13/2011 | ||||||||
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| AuthorizedOfficialLastName: | PETERMAN | ||||||||
| AuthorizedOfficialFirstName: | AMBROSE | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6103271785 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | III | ||||||||
| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QG0300X | OS004830L | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
No ID Information.