Provider Demographics
NPI:1568447803
Name:REINDL, DAVID V (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:V
Last Name:REINDL
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 1:830 WASHINGTON ST
Mailing Address - Street 2:SAMARITAN MEDICAL CENTER MEDICAL STAFF OFFICE
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-4034
Mailing Address - Country:US
Mailing Address - Phone:315-786-4824
Mailing Address - Fax:315-786-4915
Practice Address - Street 1:830 WASHINGTON ST
Practice Address - Street 2:SAMARITAN MEDICAL CENTER MEDICAL STAFF OFFICE
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-4034
Practice Address - Country:US
Practice Address - Phone:315-786-4824
Practice Address - Fax:315-786-4915
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC27113207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2489Medicaid
SCP00195036OtherRR MEDICARE
SCGP2489Medicaid
SC6161Medicare ID - Type Unspecified