Individual
JASON JOHN SANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
515 PENNSYLVANIA AVE STE A2ND, FORT WASHINGTON, PA 19034-3314
(215) 540-8408
(215) 540-8418
Mailing address
400 CHERRY TREE RD, ASTON, PA 19014-2406
(610) 485-6700
(610) 485-9540
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
OS012064
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1031173500001
—
PA
01
—
DT0827
RAILROAD MEDICARE PTAN
PA
Enumeration date
04/03/2006
Last updated
02/18/2019
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