MEDICARE: PAUL REARDON M.D.

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	MD031768E	PA
2	207P00000X	Emergency Medicine Physician	MD031768E	PA

General Provider Information

NPI Number	:	1952371080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL REARDON M.D.

Provider Business Mailing Address
First Line	:	22 W PIKE ST
Second Line	:
City	:	HOUSTON
State	:	PA
Zip	:	15342-1538
Country	:	US
Telephone Number	:	724-745-9150
Fax Number	:	724-873-5255

Provider Business Practice Location Address
First Line	:	22 W PIKE ST
Second Line	:
City	:	HOUSTON
State	:	PA
Zip	:	15342-1538
Country	:	US
Telephone Number	:	724-745-9150
Fax Number	:	724-873-5255

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	08/22/2007

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