Provider Demographics
NPI:1356595599
Name:REIDER, HORACE OLIVER (MD)
Entity type:Individual
Prefix:
First Name:HORACE
Middle Name:OLIVER
Last Name:REIDER
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:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:EAST BURKE
Mailing Address - State:VT
Mailing Address - Zip Code:05832-0010
Mailing Address - Country:US
Mailing Address - Phone:802-626-6007
Mailing Address - Fax:802-626-6007
Practice Address - Street 1:47 PARK AVE.
Practice Address - Street 2:
Practice Address - City:LYNDONVILLE
Practice Address - State:VT
Practice Address - Zip Code:05851
Practice Address - Country:US
Practice Address - Phone:802-626-6007
Practice Address - Fax:802-626-6007
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0004753208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice