Provider Demographics
NPI:1750347092
Name:SISBARRO, PAUL J (DO)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:SISBARRO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-738-5632
Mailing Address - Fax:717-738-6535
Practice Address - Street 1:175 MARTIN AVE STE 350
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1763
Practice Address - Country:US
Practice Address - Phone:717-738-5632
Practice Address - Fax:717-738-6535
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAS2305236208800000X
PA0S005165L208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001124432Medicaid
SI421533Medicare ID - Type Unspecified
PA001124432Medicaid