Individual
MARTENE JACQUELINE IMBODEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
701 OSTRUM ST STE 603, FOUNTAIN HILL, PA 18015-1184
(484) 526-3990
(610) 868-2915
Mailing address
701 OSTRUM ST STE 603, FOUNTAIN HILL, PA 18015-1184
(484) 526-3990
(610) 868-2915
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
MA059556
PA
Other
Enumeration date
01/02/2018
Last updated
01/08/2018
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