Healthcare Provider Details

I. General information

NPI: 1811969918
Provider Name (Legal Business Name): NORTHEAST MEDICAL SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 CALHOUN ST
COLUMBIA SC
29201
US

IV. Provider business mailing address

1401 CALHOUN ST
COLUMBIA SC
29201
US

V. Phone/Fax

Practice location:
  • Phone: 803-400-1201
  • Fax: 803-400-1204
Mailing address:
  • Phone: 803-400-1201
  • Fax: 803-400-1204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number15941
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number15941
License Number StateSC

VIII. Authorized Official

Name: DR. TANYA ELAINE REID
Title or Position: OWNER
Credential: MD
Phone: 803-400-1201