MEDICARE: DR. JEROME ALAN REID M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	087618	NY

General Provider Information

NPI Number	:	1225368616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEROME ALAN REID M.D.

Provider Business Mailing Address
First Line	:	445 MONKEY RUN RD
Second Line	:
City	:	PORT CRANE
State	:	NY
Zip	:	13833-1130
Country	:	US
Telephone Number	:	607-648-2299
Fax Number	:	607-648-2299

Provider Business Practice Location Address
First Line	:	445 MONKEY RUN RD
Second Line	:
City	:	PORT CRANE
State	:	NY
Zip	:	13833-1130
Country	:	US
Telephone Number	:	607-648-2299
Fax Number	:	607-648-2299

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2010
Last Update Date	:	01/06/2010

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