Provider Demographics
NPI:1609956911
Name:REYES-GARZA, AMARO S (MD)
Entity Type:Individual
Prefix:DR
First Name:AMARO
Middle Name:S
Last Name:REYES-GARZA
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 1:545 PERSHING AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-4369
Mailing Address - Country:US
Mailing Address - Phone:717-293-4150
Mailing Address - Fax:717-399-4289
Practice Address - Street 1:545 PERSHING AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-4369
Practice Address - Country:US
Practice Address - Phone:717-293-4150
Practice Address - Fax:717-399-4289
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040928L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001813132Medicaid
PA767081Medicare ID - Type Unspecified
PA001813132Medicaid