Provider Demographics
NPI:1750382701
Name:SORTOR-THOMPSON, SHERRI (MD)
Entity type:Individual
Prefix:
First Name:SHERRI
Middle Name:
Last Name:SORTOR-THOMPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1440
Mailing Address - Country:US
Mailing Address - Phone:814-371-2200
Mailing Address - Fax:
Practice Address - Street 1:1033 TURNPIKE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-3061
Practice Address - Country:US
Practice Address - Phone:814-768-7618
Practice Address - Fax:814-768-7508
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065053-L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA16973290008Medicaid
PA185255PLGOtherMEDICARE - GROUP MEMBER PTAN EFFECTIVE 6-9-10
PA16973290008Medicaid
PA012467PLGMedicare PIN