Provider Demographics
NPI:1841470739
Name:SUBERVI, JOSE SIGFREDO (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:SIGFREDO
Last Name:SUBERVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:111TH SOUTH 5TH STREET
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19602
Mailing Address - Country:US
Mailing Address - Phone:610-504-2257
Mailing Address - Fax:610-370-7768
Practice Address - Street 1:111TH SOUTH 5TH STREET
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19602
Practice Address - Country:US
Practice Address - Phone:610-504-2257
Practice Address - Fax:610-370-7768
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD047480L207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA06630Medicare UPIN
PA0014207700011Medicaid