Provider Demographics
NPI:1992737373
Name:MEJIA AGUIRRE, JOSE LUIS (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:LUIS
Last Name:MEJIA AGUIRRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:LUIS
Other - Last Name:MEJIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-466-2500
Mailing Address - Fax:717-733-7865
Practice Address - Street 1:804 GRANDVIEW DR STE 2
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-1681
Practice Address - Country:US
Practice Address - Phone:717-466-2500
Practice Address - Fax:717-733-7865
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40571208600000X
PAMD470212208600000X
NY272172208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ012133Medicaid
TNQ012133Medicaid