Provider Demographics
NPI:1619032646
Name:REITAN, RACHEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:E
Last Name:REITAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1542 TULANE AVENUE ROOM 522
Mailing Address - Street 2:DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112
Mailing Address - Country:US
Mailing Address - Phone:504-568-8663
Mailing Address - Fax:504-586-5140
Practice Address - Street 1:1542 TULANE AVE RM 522
Practice Address - Street 2:DEPARTMENT OF OBSTETRICS AND GYNECOLOGY
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2865
Practice Address - Country:US
Practice Address - Phone:504-568-8663
Practice Address - Fax:504-568-5140
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.024035207V00000X
CAA77433207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA72-042389OtherMEDICAID GROUP TAX ID
LA1485543Medicaid
LA4K0006677Medicare UPIN