Provider Demographics
NPI:1669465407
Name:REID, EMERSON (MD)
Entity Type:Individual
Prefix:DR
First Name:EMERSON
Middle Name:
Last Name: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 1:1832 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14208-1119
Mailing Address - Country:US
Mailing Address - Phone:716-885-7088
Mailing Address - Fax:716-885-7089
Practice Address - Street 1:1832 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14208-1119
Practice Address - Country:US
Practice Address - Phone:716-885-7088
Practice Address - Fax:716-885-7089
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108253-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00595639Medicaid
NY00595639Medicaid