Healthcare Provider Details

I. General information

NPI: 1689876062
Provider Name (Legal Business Name): G.R. JUNCOS, MD. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 W WELSH POOL RD MEDICAL ARTS BLDG., SUITE 206
EXTON PA
19341-1233
US

IV. Provider business mailing address

80 W WELSH POOL RD MEDICAL ARTS BLDG., SUITE 206
EXTON PA
19341-1233
US

V. Phone/Fax

Practice location:
  • Phone: 610-363-7244
  • Fax: 610-524-8446
Mailing address:
  • Phone: 610-363-7244
  • Fax: 610-524-8446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number033286-L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0006277690003
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: GUILLERMO R JUNCOS
Title or Position: OFFICER
Credential: M.D.
Phone: 610-363-7244