=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437485463
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMES F. REA, D.O., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2009
-----------------------------------------------------
Last Update Date | 10/27/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2300 COMPUTER RD J-54-A
-----------------------------------------------------
City | WILLOW GROVE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19090-1752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-830-0803
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2300 COMPUTER RD J-54-A
-----------------------------------------------------
City | WILLOW GROVE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19090-1752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-830-0803
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JAMES F REA
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 215-830-0803
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------