Provider Demographics
NPI:1013337146
Name:REICHERT, RYAN JAMES (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:JAMES
Last Name:REICHERT
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 1:733 W MARKET ST APT 511
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44303-1042
Mailing Address - Country:US
Mailing Address - Phone:330-323-9433
Mailing Address - Fax:
Practice Address - Street 1:1 PERKINS SQUARE
Practice Address - Street 2:AKRON CHILDRENS HOSPITAL
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302
Practice Address - Country:US
Practice Address - Phone:330-543-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2017-01127207PP0204X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency MedicineGroup - Multi-Specialty