Healthcare Provider Details

I. General information

NPI: 1447220322
Provider Name (Legal Business Name): GARY LEE REEDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 MT PLEASANT DR SUITE 101
SCRANTON PA
18503-1987
US

IV. Provider business mailing address

521 MT PLEASANT DR SUITE 101
SCRANTON PA
18503-1987
US

V. Phone/Fax

Practice location:
  • Phone: 570-346-7338
  • Fax: 570-341-3025
Mailing address:
  • Phone: 570-346-7338
  • Fax: 570-341-3025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD024895E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0011465740009
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: