Healthcare Provider Details

I. General information

NPI: 1700867686
Provider Name (Legal Business Name): JOSE ENRIQUE MISAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 LONDONDERRY RD SUITE 100
HARRISBURG PA
17109-5300
US

IV. Provider business mailing address

2494 BERNVILLE RD STE G02
READING PA
19605-9466
US

V. Phone/Fax

Practice location:
  • Phone: 717-221-5940
  • Fax: 717-233-2821
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD023275E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberMD023275E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: