Provider Demographics
NPI:1952346108
Name:LATIMORE-COLLIER, SHERITA (MD)
Entity Type:Individual
Prefix:
First Name:SHERITA
Middle Name:
Last Name:LATIMORE-COLLIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:SHERITA
Other - Middle Name:
Other - Last Name:COLLIER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2501 W LEHIGH AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19132-3207
Mailing Address - Country:US
Mailing Address - Phone:215-227-0300
Mailing Address - Fax:215-227-0302
Practice Address - Street 1:2501 W LEHIGH AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19132-3207
Practice Address - Country:US
Practice Address - Phone:215-227-0300
Practice Address - Fax:215-227-0302
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD068582-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017644210001Medicaid
PAG93105Medicare UPIN
PA027087Medicare PIN