Healthcare Provider Details

I. General information

NPI: 1417405895
Provider Name (Legal Business Name): COLLIN KIEFER REINHARD PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 05/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 CAREW ST
SPRINGFIELD MA
01104-2377
US

IV. Provider business mailing address

80 SEYMOUR ST SOUTH BUILDING 502
HARTFORD CT
06102
US

V. Phone/Fax

Practice location:
  • Phone: 413-748-9137
  • Fax:
Mailing address:
  • Phone: 860-972-0549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number003635
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: