Provider Demographics
NPI:1083666002
Name:REITER, SAMANTHA F (MD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:F
Last Name:REITER
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 1:840 N 5TH AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3045
Mailing Address - Country:US
Mailing Address - Phone:360-582-2850
Mailing Address - Fax:360-582-2851
Practice Address - Street 1:840 N 5TH AVE
Practice Address - Street 2:STE 100
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3045
Practice Address - Country:US
Practice Address - Phone:360-582-2850
Practice Address - Fax:360-582-2851
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041946207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8369746Medicaid
WA0197565OtherLABOR & INDUSTRIES
WA0197565OtherLABOR & INDUSTRIES
WA043600306OtherTIN
WAH83924Medicare UPIN