Provider Demographics
NPI:1487653374
Name:PRISTAS, RENE L (MD)
Entity Type:Individual
Prefix:DR
First Name:RENE
Middle Name:L
Last Name:PRISTAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:1000 E MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18711-0027
Practice Address - Country:US
Practice Address - Phone:570-808-7850
Practice Address - Fax:570-808-7855
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013690207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000000192771OtherUNISON
PA1016689100001Medicaid
PA50060462OtherCAPITAL ADVANTAGE
NJ0108928Medicaid
PA1554146OtherGATEWAY
PA2724601000OtherIBC
PA1865764OtherHIGHMARK
PA50060462OtherCAPITAL ADVANTAGE
PA1016689100001Medicaid