Provider Demographics
NPI:1134183957
Name:RECKNAGEL, JUDITH (MD)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:RECKNAGEL
Suffix:
Gender:F
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:PO BOX 905
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02541
Mailing Address - Country:US
Mailing Address - Phone:508-548-8989
Mailing Address - Fax:508-548-5789
Practice Address - Street 1:923 ROUTE 6A
Practice Address - Street 2:
Practice Address - City:YARMOUTHPORT
Practice Address - State:MA
Practice Address - Zip Code:02675
Practice Address - Country:US
Practice Address - Phone:508-362-3188
Practice Address - Fax:508-362-8599
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA44588207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
720759OtherTUFTS
80375OtherHARVARD PILGRIM
MA0150223Medicaid
MA0150223Medicaid
R39198Medicare ID - Type Unspecified