Provider Demographics
NPI:1346263688
Name:REIDY, MARGARET E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:E
Last Name:REIDY
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 1:11820 DESTINATION DR
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-2518
Mailing Address - Country:US
Mailing Address - Phone:303-464-4940
Mailing Address - Fax:303-460-6193
Practice Address - Street 1:11820 DESTINATION DR
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021-2518
Practice Address - Country:US
Practice Address - Phone:303-464-4940
Practice Address - Fax:303-460-6193
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037498E208100000X
CODR.0066404208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011910500015Medicaid
PA567533JX3Medicare PIN
PA567533R2AMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #
PA0011910500015Medicaid