MEDICARE: MARTHA REIGEL

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	35-05-6803-R	OH

General Provider Information

NPI Number	:	1710934138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA REIGEL

Provider Business Mailing Address
First Line	:	PO BOX 951144
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44193-0005
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5969 E BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-1546
Country	:	US
Telephone Number	:	614-234-0444
Fax Number	:

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

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	12/06/2007

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Directions to “ MARTHA REIGEL ” Practice Location

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