Provider Demographics
NPI:1053604132
Name:REID, NIANDA (MD)
Entity type:Individual
Prefix:
First Name:NIANDA
Middle Name:
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 1:909 SUMNEYTOWN PIKE STE 105
Mailing Address - Street 2:
Mailing Address - City:SPRING HOUSE
Mailing Address - State:PA
Mailing Address - Zip Code:19477-1011
Mailing Address - Country:US
Mailing Address - Phone:267-609-2424
Mailing Address - Fax:267-609-2425
Practice Address - Street 1:909 SUMNEYTOWN PIKE STE 105
Practice Address - Street 2:
Practice Address - City:SPRING HOUSE
Practice Address - State:PA
Practice Address - Zip Code:19477-1011
Practice Address - Country:US
Practice Address - Phone:267-609-2424
Practice Address - Fax:267-609-2425
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD451659207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology