Provider Demographics
NPI:1750330031
Name:REED, CHARLES R (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:REED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:293 COACHLIGHT TER
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-3042
Mailing Address - Country:US
Mailing Address - Phone:215-427-5454
Mailing Address - Fax:215-427-4805
Practice Address - Street 1:3601 A ST
Practice Address - Street 2:ST. CHRISTOPHER'S HOSPITAL FOR CHILDREN
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-1043
Practice Address - Country:US
Practice Address - Phone:215-427-5454
Practice Address - Fax:215-427-4805
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD009636E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006505700001Medicaid
PAC27301Medicare UPIN
PA0006505700001Medicaid