Provider Demographics
NPI:1467649723
Name:JUDITH REICHMAN MD A MEDICAL CORP
Entity Type:Organization
Organization Name:JUDITH REICHMAN MD A MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:REICHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-659-9690
Mailing Address - Street 1:2080 CENTURY PARK EAST
Mailing Address - Street 2:1009
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067
Mailing Address - Country:US
Mailing Address - Phone:310-659-9690
Mailing Address - Fax:310-277-9690
Practice Address - Street 1:2080 CENTURY PARK E
Practice Address - Street 2:1009
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2001
Practice Address - Country:US
Practice Address - Phone:310-659-9690
Practice Address - Fax:310-277-9690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35620207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1396740908OtherNPI
CAA35620Medicare PIN
CAA27849Medicare UPIN