Provider Demographics
NPI:1861464430
Name:REICHERT, PAIGE H (MD)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:H
Last Name:REICHERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:H
Other - Last Name:TARQUINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:222 22ND AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1852
Mailing Address - Country:US
Mailing Address - Phone:629-255-3486
Mailing Address - Fax:
Practice Address - Street 1:325 OLD PLEASANT GROVE RD
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-4493
Practice Address - Country:US
Practice Address - Phone:629-255-2074
Practice Address - Fax:629-255-4149
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD38056207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ021013Medicaid
TNG91189Medicare UPIN
TNQ021013Medicaid