Provider Demographics
NPI:1962815878
Name:SETYONO, DEVY AFRIANY (MD)
Entity Type:Individual
Prefix:
First Name:DEVY
Middle Name:AFRIANY
Last Name:SETYONO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BROADCASTING RD STE 200
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3206
Mailing Address - Country:US
Mailing Address - Phone:610-374-8133
Mailing Address - Fax:610-375-1206
Practice Address - Street 1:1200 BROADCASTING RD STE 200
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19610-3206
Practice Address - Country:US
Practice Address - Phone:610-374-8133
Practice Address - Fax:610-375-1206
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT206203207R00000X
390200000X
PAMD465812207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1962815878Medicaid