Basic Information
| Provider Information | |||||||||
| NPI: | 1750382701 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SORTOR-THOMPSON | ||||||||
| FirstName: | SHERRI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 809 TURNPIKE AVE | ||||||||
| Address2: | |||||||||
| City: | CLEARFIELD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168301232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8147682356 | ||||||||
| FaxNumber: | 8147682134 | ||||||||
| Practice Location | |||||||||
| Address1: | 1033 TURNPIKE AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CLEARFIELD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168303061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8147687618 | ||||||||
| FaxNumber: | 8147687508 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2005 | ||||||||
| LastUpdateDate: | 10/07/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD065053-L | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 185255PLG | 01 | PA | MEDICARE - GROUP MEMBER PTAN EFFECTIVE 6-9-10 | OTHER | 16973290008 | 05 | PA | MEDICAID |