Provider Demographics
NPI:1285620013
Name:REYNER, PETER COOPER (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:COOPER
Last Name:REYNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13579
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19612-3579
Mailing Address - Country:US
Mailing Address - Phone:484-628-0796
Mailing Address - Fax:484-334-7026
Practice Address - Street 1:4201 KUTZTOWN RD
Practice Address - Street 2:MUHLENBERG MEDICAL ASSOCIATES
Practice Address - City:TEMPLE
Practice Address - State:PA
Practice Address - Zip Code:19560-1836
Practice Address - Country:US
Practice Address - Phone:610-921-2094
Practice Address - Fax:610-921-1235
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030647 E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001575310Medicaid
PA101294Medicare PIN