Provider Demographics
NPI:1376572586
Name:PUESAN, REYNALDO (MD)
Entity Type:Individual
Prefix:MR
First Name:REYNALDO
Middle Name:
Last Name:PUESAN
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 1:319 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-4867
Mailing Address - Country:US
Mailing Address - Phone:814-723-8090
Mailing Address - Fax:
Practice Address - Street 1:33 MAIN DR
Practice Address - Street 2:
Practice Address - City:NORTH WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-5001
Practice Address - Country:US
Practice Address - Phone:814-726-4317
Practice Address - Fax:814-726-4447
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040596E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
260015303OtherRAILROAD MEDICARE #
620972Medicare PIN
260015303OtherRAILROAD MEDICARE #