Provider Demographics
NPI:1871518399
Name:REGER, DONNA PIDANE (MD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:PIDANE
Last Name:REGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 824665
Mailing Address - Street 2:LIFECARE PHYSICIANS
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-4665
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1225 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:BUILDING D, SUITE 203
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3882
Practice Address - Country:US
Practice Address - Phone:609-581-6060
Practice Address - Fax:609-581-9561
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA64515207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ215860Y71Medicare PIN