Healthcare Provider Details

I. General information

NPI: 1609770437
Provider Name (Legal Business Name): NICHOLAS RYAN REICHARDT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 BEECHMONT AVE
CINCINNATI OH
45230-4119
US

IV. Provider business mailing address

4485 PEARL LN
BATAVIA OH
45103-1111
US

V. Phone/Fax

Practice location:
  • Phone: 513-232-9100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: