Healthcare Provider Details

I. General information

NPI: 1952347254
Provider Name (Legal Business Name): CARL E REINER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 10/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E WASON AVENUE SUITE 100
SPRINGFIELD MA
01107
US

IV. Provider business mailing address

100 E WASON AVENUE SUITE 100
SPRINGFIELD MA
01107
US

V. Phone/Fax

Practice location:
  • Phone: 413-732-7426
  • Fax: 413-734-2371
Mailing address:
  • Phone: 413-732-7426
  • Fax: 413-734-2371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number31394
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: