Provider Demographics
NPI:1780641712
Name:REITER, SCOTT D (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:D
Last Name:REITER
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 1:3010 LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-5735
Mailing Address - Country:US
Mailing Address - Phone:310-399-9142
Mailing Address - Fax:310-392-4212
Practice Address - Street 1:3010 LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-5735
Practice Address - Country:US
Practice Address - Phone:310-399-9142
Practice Address - Fax:310-392-4212
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42150207P00000X, 207PH0002X, 208D00000X, 207R00000X, 207RA0401X, 208VP0000X, 207RH0002X, 207NS0135X, 202K00000X, 209800000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PH0002XAllopathic & Osteopathic PhysiciansEmergency MedicineHospice and Palliative Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No209800000XAllopathic & Osteopathic PhysiciansLegal Medicine
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXR9324308OtherSAMHSA DATA WAIVER
CA00G421500Medicaid
A48839Medicare UPIN
CAWG42150GMedicare ID - Type Unspecified
CA00G421500Medicaid