Healthcare Provider Details

I. General information

NPI: 1740303650
Provider Name (Legal Business Name): ROBERT JAY REICHLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21827 76TH AVE W #201
EDMONDS WA
98026-7901
US

IV. Provider business mailing address

21827 76TH AVE W #201
EDMONDS WA
98026-7901
US

V. Phone/Fax

Practice location:
  • Phone: 425-248-4850
  • Fax: 425-248-4856
Mailing address:
  • Phone: 425-248-4850
  • Fax: 425-248-4856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD00015532
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: