MEDICARE: REYNOLD A. PANETTIERI. M.D.P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD026841L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MD026841L	OTHER	PA	MEDICAL LICENSE LICENSE
2	1184611246	OTHER	PA	TYPE 1 NPI
3	0058288000	OTHER	PA	INDEPENDENCE BLUE CROSS
4	$$$$$$$$$	OTHER	PA	SOCIAL SECURITY #
5	0058288001	OTHER	PA	KEYSTONE HEALTH PLAN EAST

General Provider Information

NPI Number	:	1861611303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REYNOLD A. PANETTIERI. M.D.P.C.

Provider Business Mailing Address
First Line	:	830 SOLLY AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-1924
Country	:	US
Telephone Number	:	215-342-5859
Fax Number	:	215-342-6136

Provider Business Practice Location Address
First Line	:	830 SOLLY AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-1924
Country	:	US
Telephone Number	:	215-342-5859
Fax Number	:	215-342-6136

Authorized Official
Title or Position	:	OWNER
Name	:	DR. REYNOLD A PANETTIERI
Credential	:	M.D.
Telephone Number	:	215-342-5859

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	08/22/2020

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