Healthcare Provider Details

I. General information

NPI: 1487953014
Provider Name (Legal Business Name): MATTHEW J REUTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2011
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 FRIENDSHIP ST
NEWPORT RI
02840-2209
US

IV. Provider business mailing address

11 FRIENDSHIP ST
NEWPORT RI
02840-2209
US

V. Phone/Fax

Practice location:
  • Phone: 401-845-1190
  • Fax: 401-845-1073
Mailing address:
  • Phone: 401-845-1190
  • Fax: 401-845-1073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number25MA0952500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMT207791
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number061507
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD18150
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: