MEDICARE: SHAWNA REIGEL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	25MA07683900	NJ

General Provider Information

NPI Number	:	1619900586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWNA REIGEL MD

Provider Business Mailing Address
First Line	:	110 MARTER AVE
Second Line	:	SUITE 408
City	:	MOORESTOWN
State	:	NJ
Zip	:	08057-3124
Country	:	US
Telephone Number	:	856-638-1990
Fax Number	:	856-583-0359

Provider Business Practice Location Address
First Line	:	110 MARTER AVE
Second Line	:	SUITE 408
City	:	MOORESTOWN
State	:	NJ
Zip	:	08057-3124
Country	:	US
Telephone Number	:	856-638-1990
Fax Number	:	856-583-0359

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	07/08/2007

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