Provider Demographics
NPI:1457347387
Name:GUERRA, REYNALDO C (MD)
Entity Type:Individual
Prefix:DR
First Name:REYNALDO
Middle Name:C
Last Name:GUERRA
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 1:108 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
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032333E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00165006410004Medicaid
PA00165006410004Medicaid
PA415228Medicare ID - Type Unspecified