Healthcare Provider Details

I. General information

NPI: 1215473087
Provider Name (Legal Business Name): KRISTINA REID PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 DEFENSE HWY STE 210
ANNAPOLIS MD
21401-7071
US

IV. Provider business mailing address

417 FAIRMOUNT DR
EDGEWATER MD
21037-2922
US

V. Phone/Fax

Practice location:
  • Phone: 410-266-9694
  • Fax:
Mailing address:
  • Phone: 617-606-0784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: