Provider Demographics
NPI:1689876062
Name:G.R. JUNCOS, MD. P.C.
Entity Type:Organization
Organization Name:G.R. JUNCOS, MD. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:R
Authorized Official - Last Name:JUNCOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-363-7244
Mailing Address - Street 1:80 W WELSH POOL RD
Mailing Address - Street 2:MEDICAL ARTS BLDG., SUITE 206
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1233
Mailing Address - Country:US
Mailing Address - Phone:610-363-7244
Mailing Address - Fax:610-524-8446
Practice Address - Street 1:80 W WELSH POOL RD
Practice Address - Street 2:MEDICAL ARTS BLDG., SUITE 206
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1233
Practice Address - Country:US
Practice Address - Phone:610-363-7244
Practice Address - Fax:610-524-8446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA033286-L207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006277690003Medicaid
PA127130Medicare PIN
PA0006277690003Medicaid