Provider Demographics
NPI:1417910571
Name:REICH, LAURA M (DO)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:REICH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4299 SAN FELIPE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-2916
Mailing Address - Country:US
Mailing Address - Phone:832-476-3900
Mailing Address - Fax:832-476-3990
Practice Address - Street 1:5801 BREMO ROAD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1907
Practice Address - Country:US
Practice Address - Phone:804-285-0620
Practice Address - Fax:804-285-0726
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44384207R00000X
VA0102202538207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1417910571Medicaid
110010358Medicare ID - Type Unspecified
VA1417910571Medicaid
I41239Medicare UPIN