Provider Demographics
NPI:1497800460
Name:NEPOMUCENO, SHERWIN PAPA (MD)
Entity Type:Individual
Prefix:
First Name:SHERWIN
Middle Name:PAPA
Last Name:NEPOMUCENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 OSTRUM ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1000
Mailing Address - Country:US
Mailing Address - Phone:484-526-6048
Mailing Address - Fax:484-526-6500
Practice Address - Street 1:1021 PARK AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-0130
Practice Address - Country:US
Practice Address - Phone:215-536-7998
Practice Address - Fax:215-536-7476
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD438857207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA225628Medicare PIN