Provider Demographics
NPI:1053376939
Name:REICHEL, ELIAS (MD)
Entity type:Individual
Prefix:MR
First Name:ELIAS
Middle Name:
Last Name:REICHEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:BOX 450
Mailing Address - Street 2:800 WASHINGTON STREET
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111
Mailing Address - Country:US
Mailing Address - Phone:617-636-1648
Mailing Address - Fax:617-636-4866
Practice Address - Street 1:260 TREMONT STREET
Practice Address - Street 2:BWD 10
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116
Practice Address - Country:US
Practice Address - Phone:617-636-1648
Practice Address - Fax:617-636-4866
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75902207WX0108X
MAMA75902207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0108XAllopathic & Osteopathic PhysiciansOphthalmologyUveitis and Ocular Inflammatory Disease
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3095029Medicaid
MA180016258OtherRAILROAD MEDICARE
MAF29901Medicare UPIN
MAJ12635Medicare ID - Type Unspecified