Basic Information
| Provider Information | |||||||||
| NPI: | 1306843800 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOY | ||||||||
| FirstName: | REGINALD | ||||||||
| MiddleName: | DARNELL | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 S 19TH ST | ||||||||
| Address2: | STE 1B | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191461449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155454173 | ||||||||
| FaxNumber: | 2155451543 | ||||||||
| Practice Location | |||||||||
| Address1: | 520 S 19TH ST | ||||||||
| Address2: | STE 1B | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191461449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2155454173 | ||||||||
| FaxNumber: | 2155451543 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD422462 | PA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0008117 | 05 | NJ | MEDICAID | FO1515382 | 01 | PA | PA BLUE SHIELD | OTHER | 0019722730001 | 05 | PA | MEDICAID |