Provider Demographics
NPI:1386752590
Name:JUNCOS, GUILLERMO R (MD)
Entity type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:R
Last Name:JUNCOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:80 W WELSH POOL RD
Mailing Address - Street 2:MEDICAL ARTS BLDG STE 206
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1233
Mailing Address - Country:US
Mailing Address - Phone:610-363-7244
Mailing Address - Fax:610-524-8446
Practice Address - Street 1:80 W WELSH POOL RD
Practice Address - Street 2:MEDICAL ARTS BLDG STE 206
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1233
Practice Address - Country:US
Practice Address - Phone:610-363-7244
Practice Address - Fax:610-524-8446
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PA033286-L207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006277690003Medicaid
4257119OtherAETNA
PA127130Medicare PIN
4257119OtherAETNA