Provider Demographics
NPI:1083625123
Name:REITMEYER, GINA M
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:REITMEYER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 MONROE TPKE
Mailing Address - Street 2:CANTERBURY PEDIATRICS
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-2276
Mailing Address - Country:US
Mailing Address - Phone:203-452-1063
Mailing Address - Fax:203-445-8926
Practice Address - Street 1:401 MONROE TPKE
Practice Address - Street 2:CANTERBURY PEDIATRICS
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-2276
Practice Address - Country:US
Practice Address - Phone:203-452-1063
Practice Address - Fax:203-445-8926
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001501363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TINOtherCONSUMER HEALTH NETWORK
TINOtherMULTIPLAN
CT230001501CT01OtherBLUE CARE FAMILY PLAN
CTP3624783OtherOXFORD HEALTH PLANS
TINOtherPIONEER
TINOtherGREAT WEST
TINOtherNEHCA
TINOtherCOMMUNITY HEALTH NETWORK
CT2V6129OtherHEALTH NET
CT010501OtherCONNECTICARE
TINOtherPHCS
TINOtherNORTHEAST HEALTH DIRECT
TINOtherNATIONAL PROVIDER NERTWOR