Healthcare Provider Details

I. General information

NPI: 1457358343
Provider Name (Legal Business Name): BARBARA REISER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 12/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 FRIENDSHIP ST TURNER 1
NEWPORT RI
02840-2209
US

IV. Provider business mailing address

275 BROADWAY UNIT 2
NEWPORT RI
02840-2612
US

V. Phone/Fax

Practice location:
  • Phone: 401-845-1652
  • Fax: 401-845-1198
Mailing address:
  • Phone: 401-845-1472
  • Fax: 401-846-4874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD07893
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: