Provider Demographics
NPI:1356453690
Name:REED, LARRY C
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:C
Last Name:REED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 COSHOCTON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-1440
Mailing Address - Country:US
Mailing Address - Phone:740-397-5545
Mailing Address - Fax:740-397-8278
Practice Address - Street 1:307 VERNEDALE DR
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-2921
Practice Address - Country:US
Practice Address - Phone:740-397-5545
Practice Address - Fax:740-397-8278
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35048503207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0551488Medicaid
A15578Medicare UPIN
OH4040133Medicare PIN