Provider Demographics
NPI:1841291291
Name:REID, CHERYL S (MD)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:S
Last Name:REID
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 EAGLEBROOK CT
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-2137
Mailing Address - Country:US
Mailing Address - Phone:856-802-9478
Mailing Address - Fax:856-439-0006
Practice Address - Street 1:5 EAGLEBROOK CT
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-2137
Practice Address - Country:US
Practice Address - Phone:856-802-9478
Practice Address - Fax:856-439-0006
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03844200207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1831500Medicaid
NJ473153Medicare PIN
NJD19657Medicare UPIN