=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235178476
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | COLEEN MARIE REID M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 ELM ST
-----------------------------------------------------
City | DANVERS
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01923-2824
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-223-9777
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11 WEST ST
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02476-7135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-646-2007
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 203331
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------