Provider Demographics
NPI:1912224346
Name:REISER, WENDY L (DO)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:L
Last Name:REISER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-1947
Mailing Address - Country:US
Mailing Address - Phone:617-758-8485
Mailing Address - Fax:
Practice Address - Street 1:234 BROADWAY
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1947
Practice Address - Country:US
Practice Address - Phone:617-758-8485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-25
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2462572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry