Provider Demographics
NPI:1396738605
Name:REICHARD, MARK ALAN (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ALAN
Last Name:REICHARD
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 1:825 WASHINGTON STREET
Mailing Address - Street 2:SUITE 240
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3441
Mailing Address - Country:US
Mailing Address - Phone:781-769-4660
Mailing Address - Fax:781-769-0371
Practice Address - Street 1:825 WASHINGTON STREET
Practice Address - Street 2:SUITE 240
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3441
Practice Address - Country:US
Practice Address - Phone:781-769-4660
Practice Address - Fax:781-769-0371
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA41096174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAC18113OtherBLUE CROSS/BLUE SHIELD
MA0106623Medicaid
MA17006OtherHARVARD PILGRIM
MA702195OtherTUFTS
MA17006OtherHARVARD PILGRIM
MAA53794Medicare UPIN