Provider Demographics
NPI:1740231695
Name:REICH, ROBERT W (PA-C)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:REICH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3156 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-2400
Mailing Address - Country:US
Mailing Address - Phone:215-831-1100
Mailing Address - Fax:215-807-8951
Practice Address - Street 1:3156 KENSINGTON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-2400
Practice Address - Country:US
Practice Address - Phone:215-831-1100
Practice Address - Fax:215-807-8951
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA-003283-L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA046488F5ZMedicare ID - Type Unspecified
PAP27528Medicare UPIN