Provider Demographics
NPI:1649364308
Name:JORGE H. REISIN, M.D., FACS, PA
Entity type:Organization
Organization Name:JORGE H. REISIN, M.D., FACS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:H
Authorized Official - Last Name:REISIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-986-9411
Mailing Address - Street 1:5530 WISCONSIN AVE STE 1440
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4302
Mailing Address - Country:US
Mailing Address - Phone:301-986-9411
Mailing Address - Fax:301-986-9460
Practice Address - Street 1:5530 WISCONSIN AVENUE,
Practice Address - Street 2:SUITE 1440
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4302
Practice Address - Country:US
Practice Address - Phone:301-986-9411
Practice Address - Fax:301-986-9460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0013799208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC62188Medicare UPIN
MDG00168Medicare ID - Type UnspecifiedGROUP I.D.