Provider Demographics
NPI:1598712689
Name:REISLER, RONALD BRUCE (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:BRUCE
Last Name:REISLER
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 1:1734 MARYLAND AVE.
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201
Mailing Address - Country:US
Mailing Address - Phone:410-467-6040
Mailing Address - Fax:443-743-2866
Practice Address - Street 1:1734 MARYLAND AVE.
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:410-467-6040
Practice Address - Fax:443-743-2866
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD55656207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD135700361Medicaid
MD100007100Medicaid
MD609430-03 & 04OtherBLUE CROSS/BLUE SHIELD
MD609430-03 & 04OtherBLUE CROSS/BLUE SHIELD
MD135700361Medicaid
MD440003893Medicare PIN