Healthcare Provider Details

I. General information

NPI: 1114008976
Provider Name (Legal Business Name): DR. SUSAN REID
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 WHITEHALL RD
ROCHESTER NH
03867-3226
US

IV. Provider business mailing address

1 OSSIPEE RD
CAPE NEDDICK ME
03902-7156
US

V. Phone/Fax

Practice location:
  • Phone: 603-332-5211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number6032
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: