Provider Demographics
NPI:1518171776
Name:REIDY, ANDREW M (DO)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:M
Last Name:REIDY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2773 OCEAN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-4822
Mailing Address - Country:US
Mailing Address - Phone:513-292-1198
Mailing Address - Fax:
Practice Address - Street 1:820 PRUDENTIAL DR STE 713
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8209
Practice Address - Country:US
Practice Address - Phone:904-396-5682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10529207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000528946OtherANTHEM
OH2769455Medicaid
OH000000528946OtherANTHEM
OH4220711Medicare PIN