Provider Demographics
NPI:1962588764
Name:EBY, PETER REIST (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:REIST
Last Name:EBY
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 1:3737 MARKET ST
Mailing Address - Street 2:7TH FL.
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:206-384-1664
Mailing Address - Fax:
Practice Address - Street 1:3400 SPRUCE STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4206
Practice Address - Country:US
Practice Address - Phone:206-384-1664
Practice Address - Fax:206-515-5886
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA121012002085R0202X
PAMD4823302085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00898818OtherRAILROAD MEDICARE
263330OtherINTERNAL ID-MOTOR VEHICLE ID
WA8395998Medicaid
WA0272895OtherDEPT OF LABOR AND INDUSTRIES
I08329Medicare UPIN
WA8898165Medicare PIN
WA8897772Medicare PIN
263330OtherINTERNAL ID-MOTOR VEHICLE ID
WA8395998Medicaid