Basic Information
| Provider Information | |||||||||
| NPI: | 1962415067 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DY | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | REYES | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22 WALNUT ST | ||||||||
| Address2: | LAUREL HEALTH CENTER ADMINISTRATION ATTN:MARIA SMITH | ||||||||
| City: | WELLSBORO | ||||||||
| State: | PA | ||||||||
| PostalCode: | 169011526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5707230621 | ||||||||
| FaxNumber: | 5707241197 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 W WELLSBORO ST | ||||||||
| Address2: | MANSFIELD LAUREL HEALTH CENTER | ||||||||
| City: | MANSFIELD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 169331411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5706622002 | ||||||||
| FaxNumber: | 5706622025 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD040198L | PA | X | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | MD040198L | PA | X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 208000000X | MD040198L | PA | X | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.