Basic Information
| Provider Information | |||||||||
| NPI: | 1679541775 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOMMERS | ||||||||
| FirstName: | JOEL | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 828065 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191828065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006662455 | ||||||||
| FaxNumber: | 6106176280 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 E LEHIGH AVENUE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157071656 | ||||||||
| FaxNumber: | 2157070805 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 03/03/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD424843 | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A805680 | 05 | CA | MEDICAID | 1642673 | 01 | PA | HIGHMARK BS | OTHER | 1011011620002 | 05 | PA | MEDICAID | 2316953000 | 01 | PA | INDEPENDENCE BC | OTHER |