Provider Demographics
NPI:1558522334
Name:REISMAN, AMY ELAINE (PA-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ELAINE
Last Name:REISMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:ELAIN
Other - Last Name:BARNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:100 WITMER RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-2211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7300 VAN DUSEN RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-9463
Practice Address - Country:US
Practice Address - Phone:301-725-4300
Practice Address - Fax:610-834-2862
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0003776363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD147301Y1ZMedicare PIN