MEDICARE: DR. ANDREW S REISMAN 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	207QS0010X	Sports Medicine (Family Medicine) Physician	C1-0005577	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2144021	OTHER	DE	OPTIMUM CHOICE
2	4721	OTHER	DE	MID-ATLANTIC
3	0670506000	OTHER	DE	INDEPENDENCE BC/PC
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	0670506000	OTHER	DE	AMERIHEALTH/KEYSTONE
6	7911229	OTHER	DE	AETNA
7	2144021	OTHER	DE	ALLIANCE
8	2144021	OTHER	DE	MAMSI

General Provider Information

NPI Number	:	1841295912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW S REISMAN MD

Provider Business Mailing Address
First Line	:	3505 SILVERSIDE RD
Second Line	:	STE 100
City	:	WILMINGTON
State	:	DE
Zip	:	19810-4904
Country	:	US
Telephone Number	:	302-477-0900
Fax Number	:	302-477-0902

Provider Business Practice Location Address
First Line	:	3505 SILVERSIDE RD
Second Line	:	STE 100
City	:	WILMINGTON
State	:	DE
Zip	:	19810-4904
Country	:	US
Telephone Number	:	302-477-0900
Fax Number	:	302-477-0902

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/09/2007

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