Provider Demographics
NPI:1821582347
Name:MEJIA SIERRA, LUIS
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:MEJIA SIERRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:609-267-1004
Mailing Address - Fax:609-267-1044
Practice Address - Street 1:212 CREEK CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:HAINESPORT
Practice Address - State:NJ
Practice Address - Zip Code:08036-2766
Practice Address - Country:US
Practice Address - Phone:609-267-1004
Practice Address - Fax:609-267-1044
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT215176208600000X
NJ25MA127437002086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery