Provider Demographics
NPI:1255963880
Name:REED, ABIGAIL VICTORIA (PA-C)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:VICTORIA
Last Name:REED
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-9371
Mailing Address - Country:US
Mailing Address - Phone:315-788-2805
Mailing Address - Fax:315-779-5066
Practice Address - Street 1:1575 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-9371
Practice Address - Country:US
Practice Address - Phone:315-788-2805
Practice Address - Fax:315-779-5066
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-11
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-02794363A00000X, 363AM0700X, 363AS0400X
WAPA61027649363A00000X, 363AM0700X, 363AS0400X
NY032497363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS15-02794OtherPA
WAPA61027649OtherWASHINGTON STATE PA LICENSE