Provider Demographics
NPI:1740222744
Name:REEDER, LAURIE BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:BETH
Last Name:REEDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 S COUNTY TRL
Mailing Address - Street 2:SUITE 200B
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-5079
Mailing Address - Country:US
Mailing Address - Phone:401-886-0923
Mailing Address - Fax:
Practice Address - Street 1:1351 S COUNTY TRL
Practice Address - Street 2:SUITE 200B
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-5079
Practice Address - Country:US
Practice Address - Phone:401-886-0923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0062390208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCC1923OtherR/R MEDICARE GROUP #
MDP00201295OtherR/R MEDICARE PROVIDER #
MDP00201295OtherR/R MEDICARE PROVIDER #
MDS567K499Medicare PIN