Provider Demographics
NPI:1215041470
Name:REID, LISA M (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:REID
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 1:1 FEDERAL ST # 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:3 COOPER PLZ
Practice Address - Street 2:SUITE 411
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1438
Practice Address - Country:US
Practice Address - Phone:856-342-2270
Practice Address - Fax:856-365-1180
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07193100208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2802440000OtherAMERIHEALTH/KEYSRTON/IBC
NJ3K6080OtherHEALTHNET
NJ60027480OtherHORIZON NJ HEALTH
NJP3723063OtherOXFORD
NJ2257314OtherCIGNA
NJ01007803000OtherAMERICHOICE
NJ0112259Medicaid
NJ2710436OtherUNITED HEALTHCARE
NJ1419072OtherAETNA
NJ0112259Medicaid