Provider Demographics
NPI:1447274584
Name:JONES, NOBLE SIDNEY (MD)
Entity type:Individual
Prefix:
First Name:NOBLE
Middle Name:SIDNEY
Last Name:JONES
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 1:1408 S BROAD ST
Mailing Address - Street 2:FL 1
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-4808
Mailing Address - Country:US
Mailing Address - Phone:215-755-6462
Mailing Address - Fax:215-755-6487
Practice Address - Street 1:1408 S BROAD ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-4808
Practice Address - Country:US
Practice Address - Phone:215-755-6462
Practice Address - Fax:215-755-6487
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020624E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD020624EOtherMEDICAL LICENSE NUMBER
PA0054153000OtherKEYSTONE HEALTH PLAN EAST
PAC29676Medicare UPIN
PAC29676Medicare UPIN