Provider Demographics
NPI:1669401170
Name:PYERITZ, REED E (MD)
Entity type:Individual
Prefix:
First Name:REED
Middle Name:E
Last Name:PYERITZ
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 1:3400 CIVIC CENTER BLVD
Mailing Address - Street 2:2 EAST
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5127
Mailing Address - Country:US
Mailing Address - Phone:215-662-4740
Mailing Address - Fax:215-614-0298
Practice Address - Street 1:3400 CIVIC CENTER BLVD
Practice Address - Street 2:2 EAST
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5127
Practice Address - Country:US
Practice Address - Phone:215-662-4740
Practice Address - Fax:215-614-0298
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049515L208000000X, 207SG0201X, 207SG0202X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207SG0202XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Biochemical Genetics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9089101Medicaid
PA0010386480002Medicaid
B69692Medicare UPIN
PA044843Medicare ID - Type Unspecified