Provider Demographics
NPI:1205899556
Name:REEDER, MARK L (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:L
Last Name:REEDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7 HOLLAND WAY FL 1
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2997
Mailing Address - Country:US
Mailing Address - Phone:603-642-3910
Mailing Address - Fax:603-642-3940
Practice Address - Street 1:53 CHURCH ST UNIT 14
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NH
Practice Address - Zip Code:03848-3072
Practice Address - Country:US
Practice Address - Phone:603-642-3910
Practice Address - Fax:603-642-3940
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH12221207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3078051Medicaid
NH30204212Medicaid
F40629Medicare UPIN