1093901274 NPI number — MS. DEBORAH M. REID FNP-BC

Table of content: MS. DEBORAH M. REID FNP-BC (NPI 1093901274)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093901274 NPI number — MS. DEBORAH M. REID FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REID
Provider First Name:
DEBORAH
Provider Middle Name:
M.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093901274
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
312 PARK ROW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESTERTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21620-1550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-990-1202
Provider Business Mailing Address Fax Number:
410-990-1203

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
312 PARK ROW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESTERTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21620-1550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-990-1202
Provider Business Practice Location Address Fax Number:
410-990-1203
Provider Enumeration Date:
09/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  RN280341 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 79411 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 0024169074 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: R213017 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 970500 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8HE544 . This is a "MEDICARE PART B - CHINLE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 8HE545 . This is a "MEDICARE PART B - PINON" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 8HE546 . This is a "MEDICARE PART B - TSAILE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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