Healthcare Provider Details

I. General information

NPI: 1851357057
Provider Name (Legal Business Name): LISA R REID MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18383 HUDSON RD FL 2
MILTON DE
19968-3103
US

IV. Provider business mailing address

640 S. STATE STREET MAIL CODE 3055
DOVER DE
19901-3530
US

V. Phone/Fax

Practice location:
  • Phone: 302-725-3499
  • Fax: 302-725-3481
Mailing address:
  • Phone: 302-725-3499
  • Fax: 302-480-9807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC1-0006202
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: