Provider Demographics
NPI:1598824294
Name:REID DURANT, MARIE ANGELLA (MD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:ANGELLA
Last Name:REID DURANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:ANGELLA
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:451 CLARKSON AVE
Mailing Address - Street 2:E BUILDING
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2057
Mailing Address - Country:US
Mailing Address - Phone:718-245-3200
Mailing Address - Fax:
Practice Address - Street 1:451 CLARKSON AVE
Practice Address - Street 2:E BUILDING
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2057
Practice Address - Country:US
Practice Address - Phone:718-245-3200
Practice Address - Fax:718-245-5560
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208963207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H02732Medicare UPIN
854691Medicare ID - Type Unspecified