Healthcare Provider Details

I. General information

NPI: 1841291291
Provider Name (Legal Business Name): CHERYL S REID M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 EAGLEBROOK CT
MOORESTOWN NJ
08057-2137
US

IV. Provider business mailing address

5 EAGLEBROOK CT
MOORESTOWN NJ
08057-2137
US

V. Phone/Fax

Practice location:
  • Phone: 856-802-9478
  • Fax: 856-439-0006
Mailing address:
  • Phone: 856-802-9478
  • Fax: 856-439-0006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number25MA03844200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: