Healthcare Provider Details

I. General information

NPI: 1053604132
Provider Name (Legal Business Name): NIANDA REID M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2011
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 SUMNEYTOWN PIKE STE 105
SPRING HOUSE PA
19477-1011
US

IV. Provider business mailing address

909 SUMNEYTOWN PIKE STE 105
SPRING HOUSE PA
19477-1011
US

V. Phone/Fax

Practice location:
  • Phone: 267-609-2424
  • Fax: 267-609-2425
Mailing address:
  • Phone: 267-609-2424
  • Fax: 267-609-2425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD451659
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: