Basic Information
| Provider Information | |||||||||
| NPI: | 1396794400 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REYES | ||||||||
| FirstName: | VICENTE | ||||||||
| MiddleName: | EDGARDO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 67 OLD CLAIRTON RD | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152363907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126553444 | ||||||||
| FaxNumber: | 4126552228 | ||||||||
| Practice Location | |||||||||
| Address1: | 2027 LEBANON CHURCH RD FL 2 | ||||||||
| Address2: | |||||||||
| City: | WEST MIFFLIN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151222461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126553444 | ||||||||
| FaxNumber: | 4126552228 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2006 | ||||||||
| LastUpdateDate: | 05/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 020590E | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD020590E | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.