Provider Demographics
NPI:1861489312
Name:REESE, ANDREW B (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:B
Last Name:REESE
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 1:369 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NY
Mailing Address - Zip Code:13165-1654
Mailing Address - Country:US
Mailing Address - Phone:315-539-4025
Mailing Address - Fax:315-539-4128
Practice Address - Street 1:369 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:NY
Practice Address - Zip Code:13165-1654
Practice Address - Country:US
Practice Address - Phone:315-539-4025
Practice Address - Fax:315-539-4128
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211540-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02068702Medicaid
NYDD1528Medicare PIN
NY02068702Medicaid