Provider Demographics
NPI:1952374704
Name:REITKNECHT, FELICE LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:FELICE
Middle Name:LYNN
Last Name:REITKNECHT
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 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:1 GUTHRIE SQ
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-1625
Practice Address - Country:US
Practice Address - Phone:570-888-5858
Practice Address - Fax:570-887-2290
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168780-1208G00000X
PAMD042691E208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACC9269OtherRR MEDICARE GROUP
PAGU039807OtherPA MEDICARE GROUP
PA060060324OtherRR MEDICARE PIN
NY01117702Medicaid
PA0011502900001Medicaid
E13008Medicare UPIN
NYCC2120Medicare ID - Type Unspecified
PACC9269OtherRR MEDICARE GROUP