Provider Demographics
NPI:1922034867
Name:REISMAN, JERALD LEWIS (MD)
Entity type:Individual
Prefix:DR
First Name:JERALD
Middle Name:LEWIS
Last Name:REISMAN
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:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-884-8302
Mailing Address - Fax:617-887-3704
Practice Address - Street 1:151 EVERETT AVE
Practice Address - Street 2:URGENT CARE
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-1812
Practice Address - Country:US
Practice Address - Phone:617-884-8302
Practice Address - Fax:617-887-3704
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA42171207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ02319OtherBCBS
MA2094975Medicaid
MAB74228Medicare UPIN
MAP00387399Medicare PIN
MAJ02319OtherBCBS