Provider Demographics
NPI:1679541775
Name:SOMMERS, JOEL DAVID (MD)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:DAVID
Last Name:SOMMERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 828065
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-8065
Mailing Address - Country:US
Mailing Address - Phone:800-666-2455
Mailing Address - Fax:610-617-6280
Practice Address - Street 1:100 E LEHIGH AVENUE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125
Practice Address - Country:US
Practice Address - Phone:215-707-1656
Practice Address - Fax:215-707-0805
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD424843207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A805680Medicaid
PA1642673OtherHIGHMARK BS
PA1011011620002Medicaid
PA2316953000OtherINDEPENDENCE BC
CAWA80568BMedicare PIN
CAWA80568AMedicare PIN
I16473Medicare UPIN
PA083320Medicare PIN