Provider Demographics
NPI:1124011341
Name:REAMS, MARY MARTHA (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MARTHA
Last Name:REAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2057
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2057
Mailing Address - Country:US
Mailing Address - Phone:606-329-0799
Mailing Address - Fax:606-329-0947
Practice Address - Street 1:613 23RD ST STE 350
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2879
Practice Address - Country:US
Practice Address - Phone:606-408-4600
Practice Address - Fax:606-408-4605
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20802207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0545093Medicaid
KY5484OtherMEDICARE GROUP NUMBER
KY64208028Medicaid
KY0548401Medicare PIN
C74754Medicare UPIN