Healthcare Provider Details

I. General information

NPI: 1518549336
Provider Name (Legal Business Name): ROY JR MUTIA LIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 S 5TH AVE
READING PA
19611-2143
US

IV. Provider business mailing address

420 S 5TH AVE
READING PA
19611-2143
US

V. Phone/Fax

Practice location:
  • Phone: 610-375-6565
  • Fax:
Mailing address:
  • Phone: 610-375-6565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.077409
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: