Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD049515L | PA |
N | 111NI0900X | Internist | MD049515L | PA |
Y | 207SG0201X | Clinical Genetics (M.D.) | MD049515L | PA |
N | 208000000X | Pediatrician | MD049515L | PA |
NPI | 1669401170 |
---|---|
Provider Name | Reed E Pyeritz |
First Address | Philadelphia, PA 19104-5127 |
Second Address | Philadelphia, PA 19104-5127 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 29/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0010386480002 | (05) | PA |
9089101 | (05) | NJ |
B69692 | (02) |