Provider Demographics
NPI:1841295912
Name:REISMAN, ANDREW S (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:S
Last Name:REISMAN
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 1:3505 SILVERSIDE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4904
Mailing Address - Country:US
Mailing Address - Phone:302-477-0900
Mailing Address - Fax:302-477-0902
Practice Address - Street 1:3505 SILVERSIDE RD
Practice Address - Street 2:STE 100
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4904
Practice Address - Country:US
Practice Address - Phone:302-477-0900
Practice Address - Fax:302-477-0902
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0005577207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE2144021OtherOPTIMUM CHOICE
DE4721OtherMID-ATLANTIC
DE0670506000OtherINDEPENDENCE BC/PC
DE0001044101Medicaid
DE0670506000OtherAMERIHEALTH/KEYSTONE
DE7911229OtherAETNA
DE2144021OtherALLIANCE
DE2144021OtherMAMSI
DE0670506000OtherAMERIHEALTH/KEYSTONE
DE2144021OtherOPTIMUM CHOICE
DE0670506000OtherINDEPENDENCE BC/PC
DEP00275185Medicare ID - Type UnspecifiedRAILROAD MEDICARE