Healthcare Provider Details

I. General information

NPI: 1023036894
Provider Name (Legal Business Name): JOHN P. SORRENTINO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 01/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3998 RED LION RD
PHILADELPHIA PA
19114-1436
US

IV. Provider business mailing address

PO BOX 8500-6335
PHILADELPHIA PA
19178-0001
US

V. Phone/Fax

Practice location:
  • Phone: 215-612-4963
  • Fax: 215-612-4532
Mailing address:
  • Phone: 215-807-8000
  • Fax: 215-807-8235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD045207L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD045207L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: