Provider Demographics
NPI:1639208721
Name:REICHMAN, ALEXANDRA ILMA (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ILMA
Last Name:REICHMAN
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 1:1748 BRADLEY ESTATES DR
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-1644
Mailing Address - Country:US
Mailing Address - Phone:530-671-6138
Mailing Address - Fax:530-749-4578
Practice Address - Street 1:726 4TH STREET
Practice Address - Street 2:RIDEOUT MEMORIAL HOSPITAL LABORATORY
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901
Practice Address - Country:US
Practice Address - Phone:530-749-4467
Practice Address - Fax:530-749-4578
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56381207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF36182Medicare UPIN