Healthcare Provider Details

I. General information

NPI: 1366426777
Provider Name (Legal Business Name): RICHARD C. REH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 LLEWELLYN AVE. ATTN: MCXR-CR KIMBROUGH AMBULATORY CARE CENTER
FT. MEADE MD
20755
US

IV. Provider business mailing address

2480 LLEWELLYN AVE ATTN: MCXR-CR KIMBROUGH AMBULATORY CARE CENTER
FT. MEADE MD
20755
US

V. Phone/Fax

Practice location:
  • Phone: 301-677-8270
  • Fax: 301-677-8176
Mailing address:
  • Phone: 301-677-8270
  • Fax: 301-677-8176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD024472-E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: