Provider Demographics
NPI:1194797944
Name:REICH, DONALD BRADFORD (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:BRADFORD
Last Name:REICH
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 1:115 MILL ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-9106
Mailing Address - Country:US
Mailing Address - Phone:617-855-2935
Mailing Address - Fax:617-855-2699
Practice Address - Street 1:115 MILL ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-9106
Practice Address - Country:US
Practice Address - Phone:617-855-2935
Practice Address - Fax:617-855-2699
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA729432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB075974Medicaid
MAJ09805OtherBCBS MA
MAJ09805OtherBCBS MA
D80748Medicare UPIN