Provider Demographics
NPI:1629496294
Name:SUMNER, JUSTEN (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:JUSTEN
Middle Name:
Last Name:SUMNER
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3998 RED LION RD STE 106
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1439
Mailing Address - Country:US
Mailing Address - Phone:215-612-5481
Mailing Address - Fax:
Practice Address - Street 1:3998 RED LION RD STE 106
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1439
Practice Address - Country:US
Practice Address - Phone:215-612-5481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD464730207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology