Provider Demographics
NPI:1922006600
Name:JOSE, SHERRY (MD)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:JOSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:495 THOMAS JONES WAY
Mailing Address - Street 2:STE 304
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2553
Mailing Address - Country:US
Mailing Address - Phone:610-874-6448
Mailing Address - Fax:610-876-7399
Practice Address - Street 1:30 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:UPLAND
Practice Address - State:PA
Practice Address - Zip Code:19013-3955
Practice Address - Country:US
Practice Address - Phone:610-874-6448
Practice Address - Fax:610-876-7399
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2020-07-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PA424224207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA081311Medicare ID - Type Unspecified
I11812Medicare UPIN