Provider Demographics
NPI:1366404246
Name:REICHMAN, WAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:
Last Name:REICHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12814 DULANEY VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ARM
Mailing Address - State:MD
Mailing Address - Zip Code:21057-9761
Mailing Address - Country:US
Mailing Address - Phone:410-459-3433
Mailing Address - Fax:
Practice Address - Street 1:12814 DULANEY VALLEY RD
Practice Address - Street 2:
Practice Address - City:GLEN ARM
Practice Address - State:MD
Practice Address - Zip Code:21057-9761
Practice Address - Country:US
Practice Address - Phone:410-459-3433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD417492086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD348481500Medicaid
MDBR1737862OtherDEA
MD178L095BMedicare ID - Type Unspecified
MDBR1737862OtherDEA