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General NPI Number Information
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NPI Number | 1346635406
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Entity Type | Individual
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Provider Name | MATTHEW STEPHEN REEDY MD
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Gender | Male
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Dates
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Enumeration Date | 04/05/2015
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Last Update Date | 10/31/2020
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Provider Practice Location Address
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Address Line | 5783 WOOSTER PIKE
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City | MEDINA
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State | OH
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Zip | 44256-8816
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Country | US
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Telephone | 330-725-0569
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Fax | 330-662-0258
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Provider Business Mailing Address
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Address Line | 5783 WOOSTER PIKE
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City | MEDINA
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State | OH
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Zip | 44256-8816
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Country | US
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Telephone | 330-725-0569
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 35.135937
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 11018967A
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License Number State | IN
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