Provider Demographics
NPI:1316230246
Name:REEDY, NASIM NICHOLE (DO)
Entity Type:Individual
Prefix:DR
First Name:NASIM
Middle Name:NICHOLE
Last Name:REEDY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 W DIAMOND AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-1415
Mailing Address - Country:US
Mailing Address - Phone:727-215-7280
Mailing Address - Fax:
Practice Address - Street 1:806 W DIAMOND AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-1415
Practice Address - Country:US
Practice Address - Phone:727-215-7280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0081997207K00000X
FLUO2691208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH0081997OtherMARYLAND STATE LICENSE