Healthcare Provider Details

I. General information

NPI: 1346635406
Provider Name (Legal Business Name): MATTHEW STEPHEN REEDY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2015
Last Update Date: 10/31/2020
Certification Date: 10/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5783 WOOSTER PIKE
MEDINA OH
44256-8816
US

IV. Provider business mailing address

5783 WOOSTER PIKE
MEDINA OH
44256-8816
US

V. Phone/Fax

Practice location:
  • Phone: 330-725-0569
  • Fax: 330-662-0258
Mailing address:
  • Phone: 330-725-0569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35.135937
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number11018967A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: