Provider Demographics
NPI:1811137169
Name:SHIRLEY E. REDDOCH, MD, LLC
Entity type:Organization
Organization Name:SHIRLEY E. REDDOCH, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:REDDOCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-256-9987
Mailing Address - Street 1:6470 FREETOWN RD
Mailing Address - Street 2:200-29
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-4016
Mailing Address - Country:US
Mailing Address - Phone:202-256-9987
Mailing Address - Fax:410-785-3124
Practice Address - Street 1:5755 CEDAR LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2912
Practice Address - Country:US
Practice Address - Phone:202-256-9987
Practice Address - Fax:410-785-3124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0060655174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty