Provider Demographics
NPI:1487625562
Name:REICHMAN, RONALD PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:PETER
Last Name:REICHMAN
Suffix:
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 1:2212 PATRICIA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-2318
Mailing Address - Country:US
Mailing Address - Phone:310-470-1811
Mailing Address - Fax:310-474-5981
Practice Address - Street 1:1505 W AVENUE J
Practice Address - Street 2:SUITE 101
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2843
Practice Address - Country:US
Practice Address - Phone:661-945-0544
Practice Address - Fax:661-949-5006
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37038207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4427318Medicaid
CA5497318Medicaid
CAH903815OtherQME
CA107383Medicare ID - Type UnspecifiedEMC
CA4427318Medicaid