Provider Demographics
NPI:1669446738
Name:REICHEL, MARC T (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:T
Last Name:REICHEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1123
Mailing Address - Street 2:255 WEST MICHIGAN AVENUE
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49204-1123
Mailing Address - Country:US
Mailing Address - Phone:800-516-5315
Mailing Address - Fax:517-787-7365
Practice Address - Street 1:955 RIBAUT ROAD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902
Practice Address - Country:US
Practice Address - Phone:843-522-5087
Practice Address - Fax:843-522-5007
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18123207L00000X, 207LP2900X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT20233Medicaid
SCG048563072Medicare PIN
SCT20233Medicaid