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Organization
REYNOLD A. PANETTIERI. M.D.P.C.
Active
Organization
REYNOLD A. PANETTIERI. M.D.P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REYNOLD A PANETTIERI M.D. (OWNER)
(215) 342-5859
Entity
Organization
Contact information
Practice address
830 SOLLY AVE, PHILADELPHIA, PA 19111-1924
(215) 342-5859
(215) 342-6136
Mailing address
830 SOLLY AVE, PHILADELPHIA, PA 19111-1924
(215) 342-5859
(215) 342-6136
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD026841L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
$$$$$$$$$
SOCIAL SECURITY #
PA
01
—
0058288000
INDEPENDENCE BLUE CROSS
PA
01
—
0058288001
KEYSTONE HEALTH PLAN EAST
PA
01
—
1184611246
TYPE 1 NPI
PA
01
—
AP4484779
CONTROL SUBSTANCE REGISTR
PA
01
—
MD026841L
MEDICAL LICENSE LICENSE
PA
Enumeration date
04/24/2007
Last updated
08/22/2020
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