Provider Demographics
NPI:1700867686
Name:MISAS, JOSE ENRIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ENRIQUE
Last Name:MISAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2494 BERNVILLE RD
Mailing Address - Street 2:STE G02
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19605-9466
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4310 LONDONDERRY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5300
Practice Address - Country:US
Practice Address - Phone:717-221-5940
Practice Address - Fax:717-233-2821
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD023275E207V00000X, 207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008072840008Medicaid
PAE76855Medicare UPIN
PA802411D99Medicare PIN
PA132528LR4Medicare PIN