Provider Demographics
NPI:1508440215
Name:TULLOCH-REID, EDWIN EDWARDE (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:EDWARDE
Last Name:TULLOCH-REID
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 1:3 NICKS AVENUE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:KINGSTON
Mailing Address - Zip Code:00008
Mailing Address - Country:JM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27 HOPE ROAD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:KINGSTON
Practice Address - Zip Code:00010
Practice Address - Country:JM
Practice Address - Phone:876-920-7718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-09
Last Update Date:2021-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070595L207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty