Provider Demographics
NPI:1831155183
Name:REITANO, JOSEPH F JR (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:F
Last Name:REITANO
Suffix:JR
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 1:3475 W CHESTER PIKE
Mailing Address - Street 2:STE 200
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-4280
Mailing Address - Country:US
Mailing Address - Phone:610-356-0300
Mailing Address - Fax:610-356-1981
Practice Address - Street 1:3475 W CHESTER PIKE
Practice Address - Street 2:STE 200
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-4280
Practice Address - Country:US
Practice Address - Phone:610-356-0300
Practice Address - Fax:610-356-1981
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD013234E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA18075740101Medicaid
PA18075740101Medicaid
C30033Medicare UPIN