Provider Demographics
NPI:1669450938
Name:WINSTON, REED A (MD PA)
Entity Type:Individual
Prefix:
First Name:REED
Middle Name:A
Last Name:WINSTON
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4409 N CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-1010
Mailing Address - Country:US
Mailing Address - Phone:410-235-5382
Mailing Address - Fax:
Practice Address - Street 1:700 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-2350
Practice Address - Country:US
Practice Address - Phone:410-539-3360
Practice Address - Fax:410-752-3340
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD30408207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD329821301Medicaid
MDC10875Medicare UPIN
003NMedicare PIN