Provider Demographics
NPI:1821090531
Name:REICH, LAURA M (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:REICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3585 VAN TEYLINGEN DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-4875
Mailing Address - Country:US
Mailing Address - Phone:719-638-9772
Mailing Address - Fax:719-638-9914
Practice Address - Street 1:3585 VAN TEYLINGEN DR
Practice Address - Street 2:SUITE E
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-4875
Practice Address - Country:US
Practice Address - Phone:719-638-9772
Practice Address - Fax:719-638-9914
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0026942208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01269422Medicaid
CO01269422Medicaid