Provider Demographics
NPI:1043294770
Name:REISNER, ANDREW T (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:T
Last Name:REISNER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:WHITE 1 EMERGENCY ASSOCIATES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-724-4184
Practice Address - Fax:617-724-0917
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2014-09-08
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Provider Licenses
StateLicense IDTaxonomies
MA209107207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0140040Medicaid
MA209107OtherTUFTS HEALTH PLAN
MAJ23528OtherBCBS MA
MA0140040Medicaid
MAJ23528OtherBCBS MA