Individual
MARK J REGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4820 W TAFT RD, SUITE 209, LIVERPOOL, NY 13088-2800
(315) 448-6215
Mailing address
4820 W TAFT RD, SUITE 209, LIVERPOOL, NY 13088-2800
(315) 448-6215
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
145191
NY
207RI0011X
Interventional Cardiology Physician
145191
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00716981
—
NY
Enumeration date
09/23/2005
Last updated
10/02/2008
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