Healthcare Provider Details

I. General information

NPI: 1447604640
Provider Name (Legal Business Name): MR. ADAM CRAIG REICHARD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10506A MONTGOMERY RD
MONTGOMERY OH
45242-4402
US

IV. Provider business mailing address

10506A MONTGOMERY RD
MONTGOMERY OH
45242-4402
US

V. Phone/Fax

Practice location:
  • Phone: 513-865-9898
  • Fax: 513-865-9900
Mailing address:
  • Phone: 513-865-9898
  • Fax: 513-865-9900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35.142906
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: