Provider Demographics
NPI:1235192154
Name:AYNARDI, J MARC (MD)
Entity Type:Individual
Prefix:
First Name:J
Middle Name:MARC
Last Name:AYNARDI
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:PO BOX 13579
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19612-3579
Mailing Address - Country:US
Mailing Address - Phone:484-628-0796
Mailing Address - Fax:484-334-7026
Practice Address - Street 1:950B N WYOMISSING BLVD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1783
Practice Address - Country:US
Practice Address - Phone:610-898-1820
Practice Address - Fax:610-372-0164
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026417E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001114561Medicaid
PA083130Medicare PIN
PA083130Medicare PIN