Provider Demographics
NPI:1013095827
Name:REARDON, KAREN A (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:REARDON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1079 EUCALYPTUS STREET
Mailing Address - Street 2:STE A
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-4317
Mailing Address - Country:US
Mailing Address - Phone:209-284-4561
Mailing Address - Fax:209-284-4562
Practice Address - Street 1:1079 EUCALYPTUS STREET
Practice Address - Street 2:STE A
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-4317
Practice Address - Country:US
Practice Address - Phone:209-284-4561
Practice Address - Fax:209-284-4562
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG74304207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology