Healthcare Provider Details

I. General information

NPI: 1922006600
Provider Name (Legal Business Name): SHERRY JOSE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MEDICAL CENTER BLVD SUITE 305
UPLAND PA
19013-3955
US

IV. Provider business mailing address

495 THOMAS JONES WAY STE 304
EXTON PA
19341-2553
US

V. Phone/Fax

Practice location:
  • Phone: 610-874-6448
  • Fax: 610-876-7399
Mailing address:
  • Phone: 610-874-6448
  • Fax: 610-876-7399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number424224
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: