Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | OS014688 | PA |
NPI | 1003012154 |
---|---|
Provider Name | Dr. Mark Thomas Reutter |
First Address | Cherry Hill, NJ 08003-4719 |
Second Address | Media, PA 19063-5104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2007 |
Last Update Date | 10/02/2010 |