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NPI Code Detail

MEDICARE: CASEY ELIZABETH REID PA-C

MEDICARE:   CASEY ELIZABETH REID  PA-C
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
1390200000XStudent in an Organized Health Care Education/Training Program
2363AM0700XMedical Physician AssistantMA063893PA

General Provider Information

NPI Number : 1669104154
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASEY ELIZABETH REID PA-C
Provider Business Mailing Address
First Line : 823 SUNNYSIDE AVE
Second Line :
City : AUDUBON
State : PA
Zip : 19403-1822
Country : US
Telephone Number : 610-312-6354
Fax Number :
Provider Business Practice Location Address
First Line : 2310 E ALLEGHENY AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19134-4401
Country : US
Telephone Number : 215-427-1111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2022
Last Update Date : 12/07/2022

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Directions to “ CASEY ELIZABETH REID PA-C” Practice Location

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