Provider Demographics
NPI:1942260617
Name:REICHMAN, MARK V (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:V
Last Name:REICHMAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5171 COTTONWOOD ST
Mailing Address - Street 2:SUITE 950
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5704
Mailing Address - Country:US
Mailing Address - Phone:801-507-9555
Mailing Address - Fax:801-507-9550
Practice Address - Street 1:5171 COTTONWOOD ST
Practice Address - Street 2:SUITE 950
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5704
Practice Address - Country:US
Practice Address - Phone:801-507-9555
Practice Address - Fax:801-507-9550
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2013-08-14
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Provider Licenses
StateLicense IDTaxonomies
UT1732781205207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT529903586002Medicaid
UTE30735Medicare UPIN
UTP00070980Medicare ID - Type UnspecifiedRAILROAD MEDICARE
UT529903586002Medicaid