Provider Demographics
NPI:1114548492
Name:REID, KEVIN CHRISTOPHER (PA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:CHRISTOPHER
Last Name:REID
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14995 SHADY GROVE RD STE 350
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-8726
Mailing Address - Country:US
Mailing Address - Phone:301-251-1433
Mailing Address - Fax:301-424-5266
Practice Address - Street 1:14995 SHADY GROVE RD STE 350
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-8726
Practice Address - Country:US
Practice Address - Phone:301-251-1433
Practice Address - Fax:301-424-5266
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC07941363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant