Provider Demographics
NPI:1659855583
Name:REICHARD, GENEVIEVE (PA-C)
Entity type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:
Last Name:REICHARD
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:GENEVIEVE
Other - Middle Name:
Other - Last Name:KOCOLOSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:ELM AND CARLTON ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14263-3819
Mailing Address - Country:US
Mailing Address - Phone:716-845-2300
Mailing Address - Fax:
Practice Address - Street 1:ELM AND CARLTON ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14263-3819
Practice Address - Country:US
Practice Address - Phone:716-845-2300
Practice Address - Fax:716-845-3549
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NY022568363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant