Provider Demographics
NPI:1417941519
Name:REISCH, JOANNE (MD)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:REISCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1952 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-1209
Mailing Address - Country:US
Mailing Address - Phone:203-848-1803
Mailing Address - Fax:203-848-1777
Practice Address - Street 1:1952 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06517-1209
Practice Address - Country:US
Practice Address - Phone:203-848-1803
Practice Address - Fax:203-848-1777
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031169207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00131169600OtherBLUE CARE FAMILY PLAN
CT311690OtherCONNECTICARE
CT1042650OtherUNITED HEALTHCARE
CT110084295OtherRAILROAD MEDICARE
CT4372607OtherAETNA
CT010031169CT03OtherANTHEM BC/BS
CT021030OtherHEALTH NET
CT0293650-004OtherCIGNA HEALTHCARE
CT1311696Medicaid
CTZS684OtherOXFORD HEALTH PLANS
CTZS684OtherOXFORD HEALTH PLANS
CT0293650-004OtherCIGNA HEALTHCARE