Provider Demographics
NPI:1083673040
Name:SUNOO, JANE (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:SUNOO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:412 CREAMERY WAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2500
Mailing Address - Country:US
Mailing Address - Phone:610-594-7590
Mailing Address - Fax:610-594-2625
Practice Address - Street 1:520 MAPLE AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4434
Practice Address - Country:US
Practice Address - Phone:610-430-8200
Practice Address - Fax:610-594-2625
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD065684L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001709742Medicaid
PA001709742Medicaid
PAG78016Medicare UPIN