Provider Demographics
NPI:1992818736
Name:REICHELDERFER, TERRY A (MD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:A
Last Name:REICHELDERFER
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:PO BOX 572426
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91357-2426
Mailing Address - Country:US
Mailing Address - Phone:818-344-2545
Mailing Address - Fax:
Practice Address - Street 1:1301 20TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2050
Practice Address - Country:US
Practice Address - Phone:310-315-0222
Practice Address - Fax:310-828-8852
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA954231630OtherTAX ID #
CAA26005OtherMEDICAL LICENSE NUMBER
CA954231630OtherTAX ID #