Provider Demographics
NPI:1932306545
Name:REUSCHE, CHRISTIAN FERNANDO (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:FERNANDO
Last Name:REUSCHE
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 1:1305 SAND HARBOR LN
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-9643
Mailing Address - Country:US
Mailing Address - Phone:301-904-7995
Mailing Address - Fax:
Practice Address - Street 1:757 JOHNNIE DODDS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3079
Practice Address - Country:US
Practice Address - Phone:843-709-2013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL300812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry