Provider Demographics
NPI:1619153061
Name:REYNALDO C GUERRA, MD PC
Entity Type:Organization
Organization Name:REYNALDO C GUERRA, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMI
Authorized Official - Middle Name:
Authorized Official - Last Name:GARGUILO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-837-7335
Mailing Address - Street 1:108 E NORTHAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:PA
Mailing Address - Zip Code:18014-1643
Mailing Address - Country:US
Mailing Address - Phone:610-837-7335
Mailing Address - Fax:610-837-1340
Practice Address - Street 1:108 E NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:PA
Practice Address - Zip Code:18014-1643
Practice Address - Country:US
Practice Address - Phone:610-837-7335
Practice Address - Fax:610-837-1340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032333E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016500640004Medicaid
PA068570Medicare PIN
PAC33683Medicare UPIN