Provider Demographics
NPI:1427181965
Name:REED, CHARLES NELSON III (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:NELSON
Last Name:REED
Suffix:III
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 1:823 LAS TRAMPAS RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-4830
Mailing Address - Country:US
Mailing Address - Phone:925-283-6179
Mailing Address - Fax:
Practice Address - Street 1:823 LAS TRAMPAS RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4830
Practice Address - Country:US
Practice Address - Phone:925-283-6179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59105208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics