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General NPI Number Information
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NPI Number | 1023806825
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Entity Type | Individual
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Provider Name | SANGMO JE MD
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Gender | Male
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Dates
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Enumeration Date | 04/30/2025
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 4000 JOHNSON RD
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City | STEUBENVILLE
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State | OH
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Zip | 43952-2364
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Country | US
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Telephone | 740-264-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 383 GILMAN ST
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City | MALVERN
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State | PA
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Zip | 19355-1465
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Country | US
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Telephone | 215-478-5102
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 57.259211
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License Number State | OH
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