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General NPI Number Information
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NPI Number | 1639407414
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Entity Type | Individual
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Provider Name | MICHAEL ROBERT REUTTER PA-C
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Gender | Male
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Dates
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Enumeration Date | 12/07/2009
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Last Update Date | 08/12/2020
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Provider Practice Location Address
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Address Line | 175 CROSS KEYS RD STE 300A
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City | BERLIN
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State | NJ
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Zip | 08009-9263
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Country | US
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Telephone | 856-767-0077
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Fax | 856-767-6102
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Provider Business Mailing Address
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Address Line | 634 PINE STREET
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City | PHILADELPHIA
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State | PA
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Zip | 19106-4109
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Country | US
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Telephone | 215-627-1300
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Fax | 215-925-2126
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 0A000754
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License Number State | PA
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