Provider Demographics
NPI:1184787673
Name:REINHARD, ELAINE RUTH (MD)
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:RUTH
Last Name:REINHARD
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 1:519 W MONTICELLO ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-3209
Mailing Address - Country:US
Mailing Address - Phone:601-990-2963
Mailing Address - Fax:601-990-2964
Practice Address - Street 1:519 W MONTICELLO ST
Practice Address - Street 2:SUITE B
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-3209
Practice Address - Country:US
Practice Address - Phone:601-990-2963
Practice Address - Fax:601-833-0530
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17415207P00000X, 2083P0011X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05676700Medicaid
MS05676700Medicaid