Provider Demographics
NPI:1306406459
Name:REIDY, COLLEEN C (DO)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:C
Last Name:REIDY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-688-6490
Mailing Address - Fax:614-688-6491
Practice Address - Street 1:543 TAYLOR AVE FL 2
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203-1278
Practice Address - Country:US
Practice Address - Phone:614-688-6490
Practice Address - Fax:614-688-6491
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2022-10-21
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Provider Licenses
StateLicense IDTaxonomies
MI5151013953207Q00000X
MI5101026396207Q00000X
OH34016078207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine