Provider Demographics
NPI:1285664201
Name:REICH, SCOTT MICHAEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MICHAEL
Last Name:REICH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3919
Mailing Address - Country:US
Mailing Address - Phone:410-836-0131
Mailing Address - Fax:410-836-8594
Practice Address - Street 1:437 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3919
Practice Address - Country:US
Practice Address - Phone:410-836-0131
Practice Address - Fax:410-836-8594
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEEI-0000180213ES0103X
MD01537213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEEI-0000180OtherSTATE LICENSE
MD01537OtherMARYLAND STATE LICENSE
MD01537OtherMARYLAND STATE LICENSE
V10315Medicare UPIN