Provider Demographics
NPI:1467409706
Name:REILING, WALTER A III (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:A
Last Name:REILING
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 N MAIN ST
Mailing Address - Street 2:SUITE G 35
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-1180
Mailing Address - Country:US
Mailing Address - Phone:937-836-5170
Mailing Address - Fax:937-836-1140
Practice Address - Street 1:9000 N MAIN ST
Practice Address - Street 2:SUITE G 35
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-1180
Practice Address - Country:US
Practice Address - Phone:937-836-5170
Practice Address - Fax:937-836-1140
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-060935207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0900583Medicaid
OH0707002Medicare PIN
OH0707005Medicare PIN
F09352Medicare UPIN