Provider Demographics
NPI:1427041391
Name:REED, DONALD E (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:E
Last Name:REED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 FULTON ST STE C
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-2008
Mailing Address - Country:US
Mailing Address - Phone:419-732-6500
Mailing Address - Fax:419-732-1512
Practice Address - Street 1:611 FULTON ST STE C
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-2008
Practice Address - Country:US
Practice Address - Phone:419-732-6500
Practice Address - Fax:419-732-1512
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063328208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0122745Medicaid
OH0122745Medicaid
OHRE0777943Medicare ID - Type Unspecified