Individual
WILLIAM R. PREBOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
150 MUNDY ST, WILKES BARRE, PA 18702-6830
(570) 824-0930
(570) 824-7755
Mailing address
150 MUNDY ST, MAC IV BUILDING, WILKES BARRE, PA 18702-6830
(570) 824-0930
(570) 824-7755
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
MD042746L
PA
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
MD042746L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001223987-0003
—
PA
01
—
14674-1067
GEISINGER
PA
01
—
20007268
AMERIHEALTH
PA
01
—
25-1645055
UNITEDHEALTH CARE
PA
01
—
50075038
CAPITAL BLUE CROSS
PA
01
—
534521
AETNA
PA
01
—
635251
BLUE CARE
PA
01
—
800082
BLUE CARE HMO (FPH)
PA
01
—
P00120684
RAILROAD MEDICARE
PA
Enumeration date
08/30/2005
Last updated
03/20/2015
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