Healthcare Provider Details

I. General information

NPI: 1659543403
Provider Name (Legal Business Name): JAMES ANTHONY REICHERT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 PRO DR STE D2
CELINA OH
45822-3307
US

IV. Provider business mailing address

200 SAINT CLAIR AVE
SAINT MARYS OH
45885-2400
US

V. Phone/Fax

Practice location:
  • Phone: 419-586-6480
  • Fax: 419-586-8574
Mailing address:
  • Phone: 419-300-1129
  • Fax: 419-394-9575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number34.009532
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: