Healthcare Provider Details

I. General information

NPI: 1821582347
Provider Name (Legal Business Name): LUIS MEJIA SIERRA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 CREEK CROSSING BLVD
HAINESPORT NJ
08036-2766
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 609-267-1004
  • Fax: 609-267-1044
Mailing address:
  • Phone: 609-267-1004
  • Fax: 609-267-1044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMT215176
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number25MA12743700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: