Provider Demographics
NPI:1659543403
Name:REICHERT, JAMES ANTHONY (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ANTHONY
Last Name:REICHERT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:200 SAINT CLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-2400
Mailing Address - Country:US
Mailing Address - Phone:419-300-1129
Mailing Address - Fax:419-394-9575
Practice Address - Street 1:801 PRO DR
Practice Address - Street 2:STE D2
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-3307
Practice Address - Country:US
Practice Address - Phone:419-586-6480
Practice Address - Fax:419-586-8574
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.009532208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3030508Medicaid
OH9934723OtherMEDICARE GROUP PTAN
OH1184652539OtherGROUP NPI - JTDM FAMILY PRACTICE, LLC
OH0105065OtherMEDICAID GROUP
OHH035101OtherMEDICARE INDIVIDUL PTAN