Provider Demographics
NPI:1124201207
Name:PLYMOUTH PSYCHIATRIC ASSOCIATES PC
Entity Type:Organization
Organization Name:PLYMOUTH PSYCHIATRIC ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:REIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:610-270-0700
Mailing Address - Street 1:1041 GERMANTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-2449
Mailing Address - Country:US
Mailing Address - Phone:610-270-0700
Mailing Address - Fax:610-270-0202
Practice Address - Street 1:1041 GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-2449
Practice Address - Country:US
Practice Address - Phone:610-270-0700
Practice Address - Fax:610-270-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA104100000X
2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty