Healthcare Provider Details

I. General information

NPI: 1376567263
Provider Name (Legal Business Name): CHARLES R REINA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 HARDING CT
EASTON PA
18045-2581
US

IV. Provider business mailing address

6 HARDING CT
EASTON PA
18045-2581
US

V. Phone/Fax

Practice location:
  • Phone: 610-258-5165
  • Fax: 610-258-5155
Mailing address:
  • Phone: 610-258-5165
  • Fax: 610-258-5155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD018616E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: