Provider Demographics
NPI:1861661928
Name:MARVIN REICH MD PA
Entity Type:Organization
Organization Name:MARVIN REICH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:REICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-427-0009
Mailing Address - Street 1:100 S MILITARY TRL
Mailing Address - Street 2:SUITE 19
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-3032
Mailing Address - Country:US
Mailing Address - Phone:954-427-0009
Mailing Address - Fax:954-427-8300
Practice Address - Street 1:100 S MILITARY TRL
Practice Address - Street 2:SUITE 19
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-3032
Practice Address - Country:US
Practice Address - Phone:954-427-0009
Practice Address - Fax:954-427-8300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0051631207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID
FL=========OtherTAX ID
FLC09243Medicare UPIN