Healthcare Provider Details

I. General information

NPI: 1487642369
Provider Name (Legal Business Name): JEROME P REICHMISTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 QUARRY LAKE DRIVE SUITE 300
BALTIMORE MD
21209
US

IV. Provider business mailing address

2700 QUARRY LAKE DRIVE SUITE 300
BALTIMORE MD
21209
US

V. Phone/Fax

Practice location:
  • Phone: 410-377-8900
  • Fax: 410-377-3156
Mailing address:
  • Phone: 410-377-8900
  • Fax: 410-377-3156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD13922
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: